Evaluation of an Oxygen Protocol in Long-Term Care

OBJECTIVE: The purpose of this study was to determine the effect of protocol-directed recommendations for oxygen therapy implemented by respiratory therapists in skilled nursing facilities. We hypothesized that the use of an oxygen protocol would reduce the number of missing and incomplete orders and unnecessary oxygen use in skilled nursing facilities.

METHODS: We studied patients who required oxygen therapy in 17 Ohio-based skilled nursing facilities. Respiratory therapists assessed the need for oxygen therapy. Recommendations for oxygen use and orders were made in accordance with an algorithm-based protocol and guidelines established by the Ohio Department of Health. Data were prospectively collected from January 1 through March 31, 2005.

RESULTS: Of 346 eligible patients, 261 had complete data and comprised the study sample. The mean ± SD age was 83 ± 11.8 years, and 79% were male. Payer mix included Medicaid (46%), Medicare Part A (36%), private pay (11%), and hospice (7%). Orders for oxygen therapy were incomplete or missing in 18% of the population. A total of 1,175 billed days were saved, which corresponded to a cost savings of $6,768.

CONCLUSIONS: Successful implementation of an oxygen protocol can improve compliance with accreditation agency requirements by reducing the number of missing and/or incomplete orders for oxygen therapy. Financial and patient outcomes can also be enhanced by discontinuing unnecessary oxygen use and initiating oxygen therapy when clinically needed.