A Protocol to assess Oxygen Therapy

Abstract

The Blue Cross Medical Necessity Guidelines require evaluation of oxygen therapy. We have developed a protocol for evaluation of oxygen therapy by respiratory therapists. This protocol not only evaluates oxygen therapy at the flow and FIO₂ at which it is prescribed but assists the physician in determination of whether more or less oxygen is needed. If carbon dioxide retention is suspected, arterial blood gas analysis is used in the assessment; when carbon dioxide retention is not suspected, pulse oximetry is used. When oximetry is used, the respiratory therapist determines the SaO₂ on the prescribed oxygen flow or FIO₂. If the SaO₂ is < 95%, the therapist determines the oxygen flow or FIO₂ required to achieve an SaO₂ of 95%. If the SaO₂ is ⩾ 95%, the SaO₂ with the patient breathing room air is determined. If the room air SaO₂ drops to < 88%, the oxygen flow or FIO₂ required to achieve an SaO₂ of 95% is determined. At the end of the assessment, the oxygen flow or FIO₂ is returned to the prescribed settings, and the results are reported to the physician. This oxygen-therapy-assessment protocol has been well accepted by the physician staff, who have found these assessments helpful in the determination of appropriate oxygen prescriptions, and by the respiratory therapy staff, who have been able to exercise patient-evaluation and decision-making skills and to know that they have contributed to improved patient care.