Clearer national guidance on the prescribing of home oxygen therapy for patients who smoke is being called for by respiratory nurses, as the country’s first hard hitting film about the dangers goes live.
The film, which was produced by Hull community respiratory nurse specialist Julie Danby and Richard Mason, Community Safety Manager at Humberside Fire & Rescue Service, was aired to around 100 clinicians at the Yorkshire and Humber Home Oxygen Event hosted by NHS Leeds South and East Clinical Commissioning Group last week (14th Oct). [They are pictured here with the film playing on the laptop]
The event, at Thackray Medical Museum, Leeds, brought together respiratory nurses and consultants, paediatric nurses, GPs and other professionals involved in the administering of home oxygen to approximately 8000 patients in the Yorkshire and Humber region.
Delegates were shown the film, produced this summer, which warns about the potentially devastating consequences of smoking cigarettes or e-cigarettes while using home oxygen and features images of flash burns caused to face and hands and shows how quickly fire can spread in an oxygen-enriched environment.
It was produced in response to the death of a Humberside man from a house fire caused by smoking while on oxygen therapy in November 2013 and reflected research which showed that patients are well aware of the risks and the most powerful message that would stop them was knowing the risk to family members.
The film is being shown to all patients who have been prescribed home oxygen, and forms part of a talk given by Humberside Fire and Rescue to those considered most at risk due to being smokers or living with a smoker. It also advises against using other heat sources such as cookers and hairdryers in close proximity (less than 10m). Its powerful message has already influenced five patients in Humberside to quit smoking and there are plans to roll it out across the other three fire and rescue services in Yorkshire.
Ms Danby was also joined by Jacqui Pollington, Pontefract and Wakefield respiratory nurse, to chair a debate about the challenges facing health and social care practitioners involved in administering home oxygen when there is a risk the patient will smoke in close proximity.
She called on the Department for Health to issue national guidance for practitioners, who are also put at risk when visiting patient property. In London, NHS commissioners have adopted a policy that home oxygen is not provided for a patient if they smoke. However, with no national guidance, practitioners in many regions, including Yorkshire and the Humber, are having to make these decisions on a case by case basis; weighing up potential clinical benefits, ethics, patient rights, cost effective use of resources, safeguarding and liability. There is plenty of evidence to show that oxygen therapy extends life and improves quality of life for many patients; however currently there is no evidence to show whether smoking counteracts those health benefits.
At the event, Ms Danby also emphasised the importance of including the patient and effective partnership working in order to try to best make these decisions. The decision to withdraw oxygen therapy, she explained, can often be a very difficult and complex one, particularly when the patient’s health is likely to deteriorate even to the point of hospitalisation. Better links with hospitals are crucial, as home oxygen prescriptions are often reinstated to patients following hospitalisation, resulting in the patients being put back at risk.
NHS Leeds South and East Clinical Commissioning Group manages the Home Oxygen national contract and performance and monitoring for Yorkshire and Humberside. Charlotte Coles, based at the CCG as Regional Lead for Home Oxygen – Yorkshire and Humber, echoed Ms Danby’s concerns:
“Currently, practitioners are having to make some very difficult decisions about patient care, with significant safeguarding and legal implications, and no national policy to back them up. Prescribing home oxygen for patients who are often highly dependent on smoking, but also likely to be very unwell without the oxygen, has to be weighed up against significant risks. Not only for the patients themselves but also their family and friends, and residents of neighbouring properties.”
To help tackle this issue, Ms Coles is leading for the region on the development of a national risk assessment toolkit, being developed with NHS England, which will reflect best practice and help bring consistency across the country.