Writing an Oxygen Therapy Order
Oxygen therapy should be prescribed according to a target saturation range, with specific documentation of the delivery device and flow rate on the patient's chart. 1
Components of an Oxygen Order
1. Target Oxygen Saturation Range
- For most acutely ill patients: 94-98% 1
- For patients at risk of hypercapnic respiratory failure: 88-92% 1, 2
- This includes patients with COPD, morbid obesity, cystic fibrosis, chest wall deformities, neuromuscular disorders, or fixed airflow obstruction associated with bronchiectasis 1
2. Oxygen Delivery Device
Select the appropriate device based on clinical need:
- Nasal cannulae: For mild hypoxemia (1-6 L/min) 2
- Simple face mask: For moderate hypoxemia (5-10 L/min) 2
- Venturi mask: For precise oxygen concentration delivery (24-28% for hypercapnic risk patients) 1, 2
- Reservoir mask: For severe hypoxemia (15 L/min) 1, 2
3. Flow Rate or Percentage
Document the specific flow rate or percentage:
- Nasal cannulae: Start at 1-2 L/min, can increase up to 6 L/min 2
- Simple mask: Start at 5 L/min, can increase up to 10 L/min 2
- Venturi mask 24%: 2-3 L/min; 28%: 4-6 L/min 1, 2
- Reservoir mask: 15 L/min 1
4. Monitoring Instructions
- Frequency of vital sign checks (typically every 4 hours for stable patients) 1
- When to obtain arterial blood gases (within 30-60 minutes for patients at risk of hypercapnia) 1
- Parameters for alerting medical staff (e.g., if saturation falls below target range) 1
Example Order Format
Oxygen Therapy Order:
- Target O2 saturation range: [94-98%] OR [88-92%]
- Delivery device: [Nasal cannulae/Simple mask/Venturi mask/Reservoir mask]
- Flow rate/percentage: [Specify L/min or %]
- Monitoring: Check vital signs and SpO2 q4h
- Special instructions: [e.g., Obtain ABG 30-60 min after initiation for hypercapnic risk patients]Documentation Requirements
- The oxygen order must be signed on the drug chart or electronic prescribing system 1
- The target saturation range should be documented on the patient's observation chart 1
- The actual oxygen saturation, delivery device, and flow rate should be recorded on the patient's monitoring chart 1
- Nurses should sign the oxygen prescription on every drug round, confirming the patient is receiving appropriate oxygen therapy 1
Adjusting Oxygen Therapy
- If oxygen saturation is above the target range and the patient is stable, reduce the flow rate or change the delivery system to return saturation to the target range 1
- If oxygen saturation is below the target range, increase oxygen therapy according to protocol and assess the patient clinically 1
- Record any changes to the delivery system or flow rate on the observation chart after 5 minutes of treatment at the new oxygen concentration 1
Common Pitfalls to Avoid
- Failing to prescribe a target range: Every patient should have a prescribed target saturation range, even if not currently requiring oxygen 1, 3
- Inappropriate target ranges: Using 94-98% for patients at risk of hypercapnic failure or 88-92% for patients without this risk 1
- Not monitoring after changes: Always observe the patient for at least 5 minutes after starting oxygen or changing the concentration 1
- Missing arterial blood gases: Patients with target saturation of 88-92% should have blood gases measured within 30-60 minutes of starting oxygen therapy 1
- Failure to wean: Oxygen should be reduced in stable patients with satisfactory oxygen saturation 1
Special Considerations
- In emergency situations, oxygen can be given immediately without a formal prescription, but documentation must follow as soon as possible 1
- For patients with an oxygen alert card, initial therapy should follow the guidance on the card until blood gas results are available 1
- Display the target oxygen saturation range at the patient's bedside to improve compliance with appropriate oxygen delivery 3
Remember that oxygen is a drug that requires proper prescription, administration, and monitoring to ensure patient safety and optimal outcomes.