Literature Review on "Oxygen Use in Hospital Setting"

Literature Review 14 pages (6426 words) Sources: 20

[EXCERPT] . . . .

Master in Quality & Safety in Healthcare Management

Year Two, 2010-2011

Oxygen Use Monitoring in Hospitals: Literature Review

Oxygen Use Monitoring in Hospitals: Literature Review

search strategy methods and methodologies application of findings to the writer's organization

Oxygen is vital element in people life.. It is a fact that, in a normal room, the percentage of oxygen is only 21% and this amount is sufficient for healthy people. However, most patients need higher levels of oxygen to circulate blood and allow body tissues to function normally (Thannickal, 2009). Oxygen is frequently used as a form of medication in community and hospital settings by the nurses and doctors employed. Use of oxygen as a medicine is not chosen for specified situations nor it is normally prescribed by doctors as part of a medical treatment (Wilkinson, Wright and Goble, 2005). Use of high percentage of oxygen in cases of acute illnesses can save patients from experiencing rigorous form of hypoxaemia (Longphire et al., 2007).

According to Dias et al. (2008), oxygen use has certain procedures that need to be followed to make it effective without causing any negative interactions and/or complications. They argue that if oxygen is used excessively or is not monitored regularly, it can cause more harm than benefits. In an earlier study, Ukholkina et al. (2005) revealed that many hospitals have reported that deficiency of proper monitoring of oxygen has led to complications for many patients. However, they argue that the use of oxygen cannot be stopped because of its benefits.

Similarly, Bassand et al. (2007) review the guidelines presented by the British Thoracic Society on how to administer oxygen use for patients and found that sometimes hospitals fail to administer protocols of oxygen consumption. No oxygen prescriptions are usually issued, so patients may receive less or extra oxygen. This increases the cost of oxygen use. Furthermore, depending on the patient's condition, a higher or lower dose of oxygen can be damaging.

The purpose of this review is to analyze how hospitals monitor the use of oxygen. The review carries significant value for clinicians since this analysis will thoroughly cover the concept of oxygen use covered in regional, national, and international literature.

The approach adapted by the writer for reviewing the literature has been by discussing it in three different themes. They are Suitable apparatus, oxygen use monitoring by trained professionals, and the impact of high-level monitoring process.

Search Strategy

In order to collect relevant data for the results, concise and yet comprehensive information related to the topic have been compiled from articles published in Pub- med, emerald, science direct, Ovid, and Medline by individual researchers, as well as, research institutions. The aim of the study is to critically review the strengths and weaknesses of both conception and implementation of research pertinent to our topic. This section also presents new questions raised by the research and their potential for future enquiry. The keywords used to collect data had been, "oxygen use is wards," "oxygen use," "oxygen use is hospitals," "oxygen monitoring."

Evaluation of the data will be based on calculating the intended affect or the outcomes/results of the study. The method used to measure the results of the study will be the same as those found in other research synthesis studies. The writer will also look into the process with which the results are obtained so that limitations in the methods can be determined and improvements can be suggested.

Overview of the Literature

In this section the writer will review three themes emerging from the literature related to oxygen use monitoring. The writer found good number of research articles through which the selected themes had been discussed. However, the writer had to drop some articles due to major bias and poor methodologies.

Theme 1: The most suitable apparatus for monitoring oxygen levels

The writer has reviewed seven articles on monitoring oxygen levels. By analyzing these studies one can infer that the best form of monitoring oxygen levels is either invasively by arterial blood drawing or by the use of the pulse oximeter device as non-invasive method. The primary function of the pulse oximeter is to calculate the levels of oxygen saturation (SpO2) in a patient. It does this through the use of a standardized clip-on sensor, normally clipped on the earlobe or the finger of the patient being monitored. In addition, the device also helps in monitoring and identifying the initial stages of hypoxemia in the monitored patient before it becomes clear to sight (Bassand et al., 2007).

Similarly, the arterial blood gases measurements help, not just in monitoring the overall flow of oxygen and its level, but also provide additional medical data like the acid-base balance experienced by the patient. In a relevant study, the researchers explained that the primary use of the arterial blood gases is to monitor oxygen use and is irregularly used to monitor or gather additional data and the corresponding results are not obtainable immediately (Martin et al., 2005).

Slagboom et al. (2005) have found that the reason why regular monitoring is given so much importance in modern times is because it is used as the foundation for prescribing or using supplemental oxygen treatment. This was done before as well, but most of the use was done through guess work. The use oximeters and the arterial blood gasses have helped to make the decision about the supplemental oxygen therapy a lot more concrete and thorough (McNulty et al., 2005). The writer agrees with the conclusion of both these researchers and believes that the induction and use of these machines have assisted in creating accurate and precise results.

When it comes to the emergency rooms and wards, the use of pulse oximetry is mainly to monitor and examine the alterations or interactions that might occur in patients during and after the oxygen therapy has begun (Stone et al., 2009). Likewise, Bassand et al. (2007) found that researchers have highlighted the benefits of using pulse oximeter. The writer, once again, agrees with their conclusions and thinks that pulse oximeter is more preferable than arterial blood gases. That is because it is non-invasive, quick, and more acceptable by patients.

On the contrary, it is important to note here that the pulse oximeter does not give a full picture of the delivery of oxygen and its impact i.e. It does not have relevant data on the concentration of hemoglobin, on the impact it has had on the tissues and the relevancy of ventilation amongst others (Dotsenko et al., 2007). The writer argues that all machines have their limitations and that manufacturers should focus on enhancing the effectiveness of pulse oximeter so that the current holdups can be averted in the future.

Gainnier and Forel (2006) reviewed clinical studies that focused on the use of helium-oxygen on patients. They, too, used meta-analysis of research studies carried out in the past as their methodology. They found that benefits of helium-oxygen have been well documented throughout the medical literature. They found that care has to be taken though that the ratio of helium and oxygen remains balanced, as an increase in the level of oxygen in the mixture drastically decreases the overall benefits of the breathing the compound. Furthermore, if He/O2 is being used in Intensive Care Units (ICU), expert monitoring must be administered to avoid negating and damaging impacts (Gainnier and Forel, 2006). The writer agrees with the conclusion of these researchers. Maintaining oxygen levels is unique for each patient and efforts should be directed towards providing each patient his/her required dose.

Theme 2: The significance of applying oxygen apparatus by trained professionals

Eight articles have been reviewed by the writer in line with this theme and the results of his analysis reveal that several mistakes have been made whilst managing oxygen apparatus by untrained healthcare professionals. The common theme recurring in these studies is that quite often the job description of these individuals did not include managing and monitoring oxygen use; however, they had been asked to do so by the senior staff.

According to Espiritu et al. (2009) the senior staff quite often delegates oxygen monitoring authority to their juniors even though it is part of their job description. This simply means that those appointed to monitor oxygen saturation levels do not do it themselves. The found that amongst the 208 hospitals, the percentage of the "other" hospital staff dealing with oxygen use in wards had been 39%. Similarly the results also indicated that nearly 28% had delegation policies. They found that where delegation policies did not exist, monitoring of oxygen use was often carried out by untrained individuals. This is where the lucid transference of instructions and training becomes crucially important one implication of this study is that all hospitals should have a clearly written oxygen use policy, which not just explains how oxygen should be monitored but also, if necessary, how its use should be delegated.

Beasley et al. (2007) reveal that while oxygen use can help prevent serious harm it can, on the other hand,… READ MORE

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