Quality standard

Quality statement 3: Assessment for long-term oxygen therapy

Quality statement 3: Assessment for long-term oxygen therapy

Quality statement

People with stable chronic obstructive pulmonary disease (COPD) and a persistent resting stable oxygen saturation level of 92% or less have their arterial blood gases measured to assess whether they need long‑term oxygen therapy (LTOT). [2011, updated 2016]

Rationale

LTOT is used to treat stable COPD in people who have developed daytime hypoxaemia. People with COPD and a persistent resting stable oxygen saturation of 92% or less should have an assessment to find out whether LTOT is suitable for them. LTOT can improve survival, pulmonary haemodynamics, polycythaemia and neuropsychological health.

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 with stable COPD and a persistent resting stable oxygen saturation level of 92% or less who have their arterial blood gases measured to assess whether they need LTOT.

Numerator – the number in the denominator who have their arterial blood gases measured to assess whether they need LTOT.

Denominator – the number of people with stable COPD and a persistent resting stable oxygen saturation level of 92% or less.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

Outcomes

Hospital admissions for a COPD exacerbation.

Data source: COPD secondary care reports of the Royal College of Physicians National Respiratory Audit Programme and NHS Digital Hospital Episode Statistics include data on the number of people admitted to hospital with a primary diagnosis of a COPD exacerbation.

What the quality statement means for different audiences

Service providers (primary and secondary care services) ensure that systems are in place for people with stable COPD and a persistent resting oxygen saturation level of 92% or less to have their arterial blood gases measured to assess whether they need LTOT.

Healthcare professionals ensure that they measure the arterial blood gases of people with stable COPD and a persisting resting oxygen saturation level of 92% or less to assess whether they need LTOT.

Commissioners ensure that they commission services in which people with stable COPD and a persisting resting oxygen saturation level of 92% or less have their arterial blood gases measured to assess whether they need LTOT.

People with COPD that is stable and who have low levels of oxygen in their blood (when checked using a device that clips to their finger) have this confirmed by a blood test, to assess whether they need long‑term oxygen therapy. Long‑term oxygen therapy is treatment with oxygen breathed in through a tube (placed just inside the nose) or a mask connected to an oxygen supply. It is usually given for at least 15 hours during the day or night.

Definitions

Stable COPD

The absence of any of the features of a recent acute exacerbation, such as worsening breathlessness, cough, increased mucus production and change in colour of mucus. [NICE's guideline on diagnosing and managing chronic obstructive pulmonary disease in over 16s, section 1.2]

Persistent resting stable oxygen saturation

An oxygen saturation (measured with a pulse oximeter) that is persistently 92% or less when the person is in a chronic stable state and is at rest (is not and has not recently been exercising). [Expert opinion]

Long-term oxygen therapy (LTOT)

The provision of oxygen therapy for continuous use at home, usually given for at least 15 hours during the day or night. [Adapted from NICE's guideline on diagnosing and managing chronic obstructive pulmonary disease in over 16s, recommendation 1.2.62]

Assessment for LTOT

Assessing people for LTOT should comprise measuring arterial blood gases on 2 occasions at least 3 weeks apart in people who have a confident diagnosis of COPD, who are receiving optimum medical management and whose COPD is stable. [NICE's guideline on diagnosing and managing chronic obstructive pulmonary disease in over 16s, recommendation 1.2.57, and British Thoracic Society's guideline for oxygen use in adults in healthcare and emergency settings, recommendation C1]

Equality and diversity considerations

Be aware that some pulse oximeters can underestimate or overestimate oxygen saturation levels, especially if the saturation level is borderline. Overestimation has been reported in people with dark skin. See also the NHS England Patient Safety Alert on the risk of harm from inappropriate placement of pulse oximeter probes.