HOME OXYGEN SERVICE

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• HOME OXYGEN SERVICE
• Georgina Thomas
• February 2008

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HISTORY OF OUR SERVICE

• Pre Feb 2006 Home Oxygen Redesign Group Set up.
• Successful LDP bid for 2.8 wte extra community
  respiratory nurses (4.8 wte total)
• 1.2.06 Air Products awarded contract.
• 1.10.06 BOC Vitalair took over contract following
  numerous supply failures

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OUR REGION

• 500,000 population (doubles in summer months)
• 1300 home oxygen patients
• 14 share of SW region
• Large rural area with no motorways!
• Large elderly population
• High prevalence of COPD in specific areas
• High levels of deprivation in specific areas

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How we made the contract into a Service for our
patients .

• April 2006
• Cornwall had 4.8 wte community respiratory
  nurses. Each nurse was given a specific area and
  approximately 13-14 GP practices. Each GP had a
  named contact.
• November 2006
• Oxygen assessment clinics were set up in
  Community Hospitals 6 in total.
• 3 are run by respiratory nurses with consultant
  support.
• 3 are run by consultants and a GPwSI with nurse
  support.

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How we made the contract into a Service for our
patients .

• All nurses were trained in arterial blood gas
  analysis.
• A respiratory LIG was formed incorporating
  consultant, community and secondary respiratory
  nurses, community matrons and a member of the
  Breathe Easy Group. This provided greater
  communication and an improved working
  relationship between primary and secondary care.
• All nurses keep strong links with the local
  Breathe Easy groups.
• All patients had a direct contact to their named
  respiratory nurse.

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How we made the contract cost effective for the
PCT

• Pilot review of one surgery showed significant
  cost savings if patients categories were
  reviewed.
• GPs had overestimated ambulatory usage of
  patients.
• April 2007 Home Oxygen Review Co-ordinator
  (clinical administrative background) was
  appointed on a 6 month secondment.

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Patient telephone review.

• Patients were reviewed by telephone over a 6
  month period.
• Relevant patients whose usage did not match their
  appointed category were re-HOOFed.
• Cost savings were calculated on a per annum basis
• Cost savings amounted to approx 700,000 pa.

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Patient Database Cleanse

• Following the Air Products period the database
  was clearly out of date.
• Time was spent cleansing this database deceased
  patients, erroneous patients were all amended and
  credit notes from BOC raised.
• The database was then made into a master copy.
  Each month the master is amended. This gives
  the PCT an accurate database with standard
  surgery names, BOC have as yet failed to provide
  this in their monthly database.

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Monthly Reconciliation

• As Cornwall work from a master database,
  additions and deletions have to be amended each
  month.
• This provides the PCT with a very clear alert
  system if patients are incorrectly aligned to our
  PCT.
• Each respiratory nurse has an up to date patient
  database for their surgeries each month.
• The database is colour coded each patient has a
  colour depicting whether they have been reviewed,
  if they have been reviewed and are awaiting a
  tariff change by BOC or remain unreviewed. This
  gives the nurses a basic but effective triage
  system for reviewing their patients.
• All new patients each month are coloured
  differently. The nurses know these patients need
  to be reviewed within 6 weeks.

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Stepping stones and setbacks.

• At GP Prescribing Leads meetings it became
  evident that the GPs were unsure how to order
  home oxygen.
• In response to this the LIG provided an A5
  laminated card of Cost Effective Guidelines for
  Home Oxygen Ordering for each GP in the county.
• These cards provided the contact number for their
  nominated respiratory nurse.

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Effective auditing

• Whilst all the reviews provided significant
  savings it became evident due to the transient
  nature of home oxygen patients, that ongoing
  systematic review would be required.
• With all the will in the world you will get the
  odd patient who is inappropriately prescribed
  home oxygen. These problems need to be resolved
  quickly and effectively be telephone review.
• Home Oxygen Review Co-ordinator and respiratory
  nurses work closely as a team to ensure the most
  appropriate patient review is conducted.

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IN SUMMARY .. PATIENT BENEFITS

• Named respiratory nurse for patient and GP
• Improved patient assessment and follow up service
  new patients reviewed within 6 weeks
• Pulmonary rehabilitation clinics
• LTOT clinics ensuring appropriate usage
• Patients receive a good home oxygen service but
  at the most cost effective category for their
  usage

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In Summary.. PCT/GP/Secondary Care Benefits

• Significant cost savings
• An accurate and effective patient database system
• Improved team working from GP to respiratory
  nurse to secondary care
• Respiratory nurses now have rapid access to
  secondary care facilities and also advice and
  support
• Surgeries are now more aware of who to contact
  for help with home oxygen.
• Clinicians have a better understanding of the new
  service through clinical guidelines devised by
  respiratory and cardiac specialists.

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ANY QUESTIONS??

• ?