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%. [new 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

Structure

Evidence of local arrangements and written clinical protocols to ensure that people receiving emergency oxygen for an acute exacerbation of COPD have their oxygen saturation levels maintained between 88% and 92%.

Data source: Local data collection. Royal College of Physicians' National COPD Audit Programme.

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.

Outcomes

a) Frequency of non‑invasive ventilation due to oxygen toxicity.

Data source: Local data collection. Royal College of Physicians' National COPD Audit Programme.

b) Morbidity rates.

Data source: Local data collection. Royal College of Physicians' National COPD Audit Programme.

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 (2018, updated 2019) NICE guideline NG115, recommendation 1.3.30

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 sputum production and change in the colour of the sputum.

[Adapted from NICE's guideline on chronic obstructive pulmonary disease]