An audit of supplemental oxygen prescribing practices in an inpatient setting and its financial burden.

Abstract

Introduction: Health care cost is 17.6% of GDP in the USA and 8%, is lost due to unnecessary services. In a resource-limited world, significant emphasis should be on prudent and practical use without wastage. Supplemental oxygen is very frequently prescribed, improperly monitored and poorly titrated, especially in the inpatient setting. Overuse of supplemental oxygen causes airway dryness and potential harm in addition to being an added financial burden. Evidence on how frequently supplemental oxygen is overprescribed and insufficiently monitored in an underserved community is lacking. Methods: 1161 inpatients in a Brooklyn state hospital were reviewed prospectively and patients on supplemental oxygen via nasal cannula were identified. Patients on supplemental oxygen were examined and electronic medical records were reviewed for an indication of use(Objectively and subjectively). Results: Of all 1161 patients reviewed, 121 (10.4%) were on supplemental oxygen. Among the 121 patients, only 23 (19%) had a clear indication for oxygen supplementation. Among the 121 patients on supplemental oxygen 64 (53%) had no active order for supplementation while 69 (57%) had no continuous bedside pulse oximetry monitoring. The mean dose of supplemental oxygen was 2.5 L/min. Conclusion: In our hospital, 1 in 10 inpatients are on supplemental oxygen and 80% of oxygen supplementation is without a clear indication. For an average use of 2.5 liters/min of supplemental oxygen for 24 hours the projected financial implication is to the tune of $250. These issues can be addressed and potentially decreased by education of healthcare professionals as well as improved auditing of oxygen supplementation.