NLHEP
National Lung Health Education Program www.nlhep.org
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Guide to Prescribing Home Oxygen
by Thomas L. Petty, M.D.
Contents
The Key to Prescibing Home Oxygen
Keys to Successful Treatment
Patient Considerations in Selecting Equipment
KEYS TO SUCCESSFUL TREATMENT
Patient
Compliance
Patient compliance with the initial LTOT prescription is always an issue. Both the physician and the equipment provider should reinforce education and understanding of the need for continual compliance. Many patients are embarrassed to be seen in public, particularly a patient using a cannula. For highly active patients, transtracheal catheters can be considered. Generally, the more inconspicuous patients can appear the more likely they are to reestablish a more normal lifestyle.
Home Care Provider Participation
The Home Care Provider (HCP) plays an important role in a patient's long-term oxygen therapy. There are a number of services that should be provided by a HCP. The Joint Commission on Accreditation ofHealthcare Organizations (JCAHO) is a regulatory body that evaluates some of these services. JCAHO participation is voluntary, and the provider pays to have the accreditation evaluations, usually every three years. Most HCP's will offer 24-hour emergency service and be available through an answering service. This allows the patient to have a contact in the event of an emergency such as a power failure or equipment malfunction. The HCP should also provide the patient with a backup system or extra cylinders in the event of inclement weather. This is particularly important if the patient is on an oxygen concentrator and there is a chance of extended power outages. When patients are on liquid oxygen the reservoir itself serves as a back up system since liquid oxygen does not use electricity to operate.
The HCP is responsible for billing the patient's insurance and the patient for any portion they are accountable for. Additional responsibilities of the HCP include patient/caregiver education in proper, safe use of equipment and maintenance and cleaning of any semidisposable accessories. The HCP must also provide the patient with an appropriate amount of disposable items such as cannulas and humidifiers at no additional cost to the patient.
Proper
Selection of the Equipment
Care should be given to selecting the best type of oxygen equipment to fit the individual patient's needs. Patients frequently resist changing oxygen modalities once they have initially adapted and become comfortable with the characteristics of the equipment. Encumbering potentially active patients with ill-suited oxygen delivery systems is counterproductive. A portable E cylinder and a cart are satisfactory for backup and infrequent use outside the home but can substantially hinder a patient who is highly ambulatory in his attempts to regain his lifesryle.
Weight and duration of oxygen flow are primary factors in selecting an ambulatory system. The Fourth Consensus Conference on Oxygen Therapy differentiated between portable and ambulatory oxygen systems. Portables are easily moved oxygen devices that are not designed to be carried and weigh above 10 Ibs. E cylinders mounted on carts typify these. Ambulatory systems are defined as systems weighing less than 10 Ibs., designed to be carried and lasting 4 hours or more at 2 EPM. These are normally small aluminum cylinders with oxygen conservers or small liquid oxygen vessels.
Most patients find 8.5 Ibs. a practical weight to carry, but smaller framed patients may be better served with a unit in the 5 Ib. range. Most ambulatory systems in the 5 Ib. range use a conserver to increase duration. Care should be taken in selecting conservers to make sure that the desired oxygen saturation of >90% is achieved during activities of daily living and during sleep. Pulse type conservers deliver a fixed volume each time they are triggered. If the I:E ratio of the patient varies from that assumed by the designers, the volume received will not be equivalent to continuous flow at the same liters per minute (LPM) setting. The more oxygen a conserver claims to save, the less it delivers. Verification of conserver performance during a particular activity of daily living is recommended via pulse oximetry measurement while the patient is using the device.