Quality standard
Quality statement 3: Assessment for oxygen therapy
Quality statement 3: Assessment for oxygen therapy
Quality statement
People with idiopathic pulmonary fibrosis have an assessment for home and ambulatory oxygen therapy at each follow‑up appointment and before they leave hospital following an exacerbation of the disease.
Rationale
Oxygen therapy relieves symptoms of breathlessness. Exercise can cause a greater reduction in levels of oxygen in the blood in people with idiopathic pulmonary fibrosis than in people with other lung diseases, and higher flow rates of oxygen can be needed to correct this. Therefore, oxygen therapy can help people to take part in pulmonary rehabilitation exercises to improve their quality of life and maintain their lung function. Assessment of a person's need for home and ambulatory oxygen therapy before they leave hospital after admission for treatment of an exacerbation of idiopathic pulmonary fibrosis will help to identify changes in their oxygen needs and may prevent a further exacerbation. Repeating the assessment at regular intervals will ensure that people with idiopathic pulmonary fibrosis receive oxygen therapy when they need it.
Quality measures
Structure
a) Evidence of local arrangements to ensure that people with idiopathic pulmonary fibrosis have an assessment for home and ambulatory oxygen therapy considered at each follow‑up appointment.
Data source: Local data collection.
b) Evidence of local arrangements to ensure that people with idiopathic pulmonary fibrosis are assessed for home and ambulatory oxygen therapy before discharge if they have been admitted to hospital because of an exacerbation of the disease.
Data source: Local data collection.
Process
a) Proportion of idiopathic pulmonary fibrosis follow‑up appointments at which an assessment for home and ambulatory oxygen therapy was made.
Numerator – the number in the denominator at which assessment for home and ambulatory oxygen therapy was carried out.
Denominator – the number of follow‑up appointments for people with idiopathic pulmonary fibrosis.
Data source: Local data collection.
b) Proportion of hospital stays because of an exacerbation of idiopathic pulmonary fibrosis during which an assessment for home and ambulatory oxygen therapy was made.
Numerator – the number in the denominator during which an assessment for home and ambulatory oxygen therapy was carried out before discharge.
Denominator – the number of hospital stays because of an exacerbation of idiopathic pulmonary fibrosis.
Data source: Local data collection.
What the quality statement means for different audiences
Service providers (hospitals and regional specialist centres) ensure that home and ambulatory oxygen therapy is available for people with idiopathic pulmonary fibrosis. They ensure that arrangements are in place for an assessment for home and ambulatory oxygen therapy to be made before discharge for people who are admitted to hospital because of an exacerbation of idiopathic pulmonary and at every follow‑up appointment for idiopathic pulmonary fibrosis.
Healthcare professionals ensure that they assess people's need for home and ambulatory oxygen therapy at follow‑up appointments and before discharge if they have been admitted to hospital because of an exacerbation of idiopathic pulmonary fibrosis.
Commissioners (NHS England through specialised services and clinical commissioning groups) ensure that the services they commission for people with idiopathic pulmonary fibrosis include assessment for home and ambulatory oxygen therapy at follow‑up appointments and before they are discharged if they are admitted to hospital because of an exacerbation of idiopathic pulmonary fibrosis.
People with idiopathic pulmonary fibrosis will have an assessment to find out whether oxygen therapy (extra oxygen) to use at home would help to ease their symptoms. This assessment will be done at every check‑up and, if they are in hospital because of a flare‑up of their condition, before they leave hospital.
Source guidance
Idiopathic pulmonary fibrosis in adults: diagnosis and management. NICE guideline CG163 (2013, updated 2017), recommendations 1.5.8 and 1.6.1 (key priority for implementation)
Definitions of terms used in this quality statement
Assessment for oxygen therapy
Assessment for oxygen therapy is the process of deciding whether to prescribe oxygen to a person and how much to give them. This assessment may take account of whether the person with idiopathic pulmonary fibrosis is experiencing breathlessness and, based on clinical judgement, may involve blood gas tests and specific local protocols. [Expert opinion]
Oxygen therapy
Oxygen therapy involves breathing air with a higher concentration of oxygen. In someone with impaired lung function resulting in reduced oxygen levels, oxygen therapy can help to overcome breathlessness by increasing the level of oxygen. Oxygen therapy is prescribed for use at home or during exercise and activities of daily living (ambulatory oxygen therapy). [Expert opinion]
Follow-up appointments
Appointments that are considered for people with idiopathic pulmonary fibrosis:
-
every 3 months or sooner if they are showing rapid disease progression or rapid deterioration of symptoms or
-
every 6 months or sooner if they have steadily progressing disease or
-
initially every 6 months if they have stable disease and then annually if they have stable disease after 1 year.
[NICE's guideline on idiopathic pulmonary fibrosis in adults, recommendation 1.6.2]