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Home Oxygen Service -

Assessment and Review (HOS-AR)

Janice QuartonAdvanced Nurse

Specialist Respiratory Medicine

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What is HOS-AR?

• Provision of a systematic integrated oxygen service

• Provision of easy access to assessment and follow up procedures via appropriately qualified and trained healthcare professionals using appropriate diagnostic equipment

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What is HOS-AR?• Reduce/eliminate waste and poor quality

care, strengthen affordability and value, through targeting the service on those who will benefit from home oxygen

• Ensure a higher standard of clinical treatment and improved outcomes, through more effective and speedier diagnosis

• Provide the users with a positive experience of care

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Why Do We Need It?

• Oxygen service review in 2010 identified 85,000 patients in England on oxygen at a cost to the NHS of £110 million a year

• Between 24 and 43% of oxygen prescribed is either not used or does not give any clinical benefit

• Oxygen is charged for each patient whether used or not

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Aim of HOS-AR

• Have quality at its core i.e. be accessible, safe and responsive to patients

• Be evidenced based, clinically led and continually strive to improve outcomes for patients

• Be affordable and represent good value for money

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Change in Oxygen Contracts• May 2012 new oxygen contracts came into

use and changes in access to HOOFs occurred

• Non specialists can only access limited oxygen equipment via HOOF A

• Specialists now have responsibility for choosing the equipment for the patients

• A change in the way charges are applied was introduced

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Local HOS-AR

• Meetings between CCG and secondary care to develop service specifications

• Agree referral pathways

• Develop referral proforma

• Recruit appropriately trained nurses to deliver service

• Develop a service operational policy

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Local HOS-AR

• Provide education to both primary and secondary healthcare professionals regarding the role of oxygen and the service

• Organise locations across the CCG for provision of assessment

• Develop an effective and active register of all oxygen patients identifying areas for review and ongoing assessment

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Local HOS-AR Inclusion/Exclusion

• Inclusion– Adult patients with oxygen saturations ≤92%

breathing air– Patient is clinically optimised in primary care– Treatment for end of life care if patient is

hypoxaemic– Completed referral form

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Local HOS-AR Inclusion/Exclusion

• Exclusion– Patients under 18 years– A non-hypoxaemic breathless patient– SpO2 >92%– Patients that smoke– Patients who have not been clinically stable

for 6 weeks– The above may not be an exhaustive list anad

consideration will be given in individual circumstances

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Key Messages

• Oxygen is not a treatment for breathlessness

• Do not issue oxygen when resting SpO2 is >92%

• Refer patients to the HOS-AR team for assessment– Therapeutic oxygen via Choose and Book– Palliative oxygen via clinician to clinician

discussion and faxed referral form

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