What are the steps to write an oxygen order?

How to Write an Oxygen Order

An oxygen order should include the target oxygen saturation range, delivery device, flow rate, and duration of therapy, with clear instructions for titration to maintain the target saturation range. 1

Essential Components of an Oxygen Order

1. Target Oxygen Saturation Range

• For most patients: 94-98% 1
• For patients at risk of hypercapnic respiratory failure (e.g., COPD, severe chest wall/spinal disease, neuromuscular disease, severe obesity, cystic fibrosis, bronchiectasis): 88-92% 1

2. Delivery Device

Select the appropriate device based on patient needs:

• First-line: Nasal cannulae (1-6 L/min) 1
• Alternatives:
  • Simple face mask (5-10 L/min)
  • Venturi mask (24-60% at appropriate flow rates)
  • Reservoir mask (15 L/min) for critically ill patients

3. Initial Flow Rate

• Start with the lowest flow necessary to achieve target saturation:
  • Nasal cannulae: Start at 1-2 L/min, titrate up to 6 L/min
  • Simple face mask: 5-10 L/min
  • Venturi mask: Set flow according to percentage needed (e.g., 24% at 2-3 L/min, 28% at 4-6 L/min) 1

4. Titration Instructions

• Include clear instructions for healthcare providers to adjust oxygen concentration to maintain the target saturation range 1
• Specify when to notify medical staff (e.g., if patient requires increasing oxygen therapy or if there is a rising NEWS score) 1

5. Duration of Therapy

• Specify if continuous or intermittent
• For home oxygen, specify minimum hours per day (typically 15 hours, up to 24 hours for additional benefits) 2

Sample Oxygen Orders

For General Medical Patient:

Oxygen via nasal cannulae at 2 L/min
Target SpO2: 94-98%
Titrate flow rate between 1-6 L/min to maintain target saturation
Notify physician if unable to maintain SpO2 within target range or if requiring >4 L/min

For COPD Patient:

Oxygen via Venturi mask 24% (2-3 L/min)
Target SpO2: 88-92%
Titrate oxygen to maintain target saturation
Notify physician immediately if respiratory rate increases or consciousness decreases
Check arterial blood gases within 1 hour of starting oxygen

Special Considerations

Critical Illness

• For critically ill patients, start with reservoir mask at 15 L/min until stabilized 1
• Document this as emergency oxygen therapy if initiated before formal prescription

Nebulizer Therapy

• For patients not at risk of hypercapnia: Use oxygen-driven nebulizers
• For patients at risk of hypercapnia: Use air-driven nebulizers with supplemental oxygen via nasal cannulae if needed 1

Documentation Requirements

• All oxygen therapy must be documented on the patient's medication chart or electronic record 1
• Record the delivery device and flow rate using standardized abbreviations
• Document SpO2 readings before and after adjustments

Common Pitfalls to Avoid

1. Not specifying a target saturation range - This is the most important part of the prescription 1
2. Prescribing fixed flow rates without titration instructions - Oxygen needs may change
3. Failing to identify patients at risk of hypercapnia - These patients require lower target saturations
4. Not documenting emergency oxygen use - All oxygen administration must be recorded retrospectively if given in an emergency 1
5. Inadequate monitoring - Ensure pulse oximetry is available wherever oxygen is used 1

Remember that oxygen is a medication and requires the same careful prescription and monitoring as any other drug. The prescription should empower healthcare providers to adjust oxygen delivery to maintain the patient within their target saturation range.