Quality standard
Quality statement 6: Emergency oxygen during an exacerbation
Quality statement 6: Emergency oxygen during an exacerbation
Quality statement
People receiving emergency oxygen for an acute exacerbation of chronic obstructive pulmonary disease (COPD) have their oxygen saturation levels maintained between 88% and 92%. [2016]
Rationale
During an exacerbation, people with COPD may experience a worsening of gas exchange in the lungs, which can lead to low blood oxygen levels. Emergency oxygen is often given during the treatment of an exacerbation, either in the community, during transfer to hospital in an ambulance or while being assessed at hospital.
In some people, uncontrolled oxygen therapy may reduce the depth and frequency of breathing, leading to a rise in blood carbon dioxide levels and a fall in the blood pH (acidosis). Controlled oxygen therapy must therefore be administered by a delivery device and at a flow rate that helps the oxygen saturation to be maintained between 88% and 92%.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Process
Proportion of people receiving emergency oxygen for an acute exacerbation of COPD who have their oxygen saturation levels maintained between 88% and 92%.
Numerator – the number in the denominator whose oxygen saturation levels are maintained between 88% and 92%.
Denominator – the number of people with an acute exacerbation of COPD receiving emergency oxygen.
Data source: COPD secondary care reports of the Royal College of Physicians National Respiratory Audit Programme include data on the first recorded respiratory rate for a person following their arrival at hospital for a COPD exacerbation.
Outcomes
Frequency of non‑invasive ventilation due to oxygen toxicity.
Data source: COPD secondary care reports of the Royal College of Physicians National Respiratory Audit Programme include data on people receiving any supplemental oxygen when in hospital for a COPD exacerbation.
What the quality statement means for different audiences
Service providers (community and secondary care services, ambulance trusts, A&E departments) ensure that devices and flow rates are used to enable oxygen saturation levels to be maintained between 88% and 92% in people receiving emergency oxygen for an acute exacerbation of COPD.
Healthcare professionals ensure that devices and flow rates are used to enable oxygen saturation levels to be maintained between 88% and 92% in people receiving emergency oxygen for an acute exacerbation of COPD.
Commissioners ensure that they commission services that use devices and flow rates to enable oxygen saturation levels to be maintained between 88% and 92% in people receiving emergency oxygen for an acute exacerbation of COPD.
People with COPD who need emergency oxygen because of a sudden flare up of their symptoms (called an acute exacerbation) receive the correct amount of oxygen to keep the oxygen levels in their blood at a safe level.
Source guidance
Chronic obstructive pulmonary disease in over 16s: diagnosis and management. NICE guideline NG115 (2018, updated 2019), recommendation 1.3.26, 1.3.27 and 1.3.29
Definition of terms used in this quality statement
Acute exacerbation
An exacerbation is a sustained worsening of a person's symptoms from their stable state beyond usual day‑to‑day variations and is acute in onset. Commonly reported symptoms are worsening breathlessness, cough, increased mucus production and change in the colour of the mucus. [Adapted from NICE's guideline on diagnosing and managing chronic obstructive pulmonary disease in over 16s, terms used in this guideline]