Daryl Freeman GP Norfolk Robert Isherwood ECP EEAST Introducing the "6 minute cycle”: for emergency administration of oxygen to East of England Ambulance Trust (EEAST) Daryl Freeman GP Norfolk Robert Isherwood ECP EEAST

Oxygen is the most commonly used drug in emergency medicine 34% of emergency ambulance patients receive oxygen 58% of patients with COPD are recognised by ambulance crews 73% treated with inappropriate high flow oxygen (Hale KE, Gavin C, O’Driscoll 2008) Hale KE, Gavin C, O’Driscoll BR. An audit of oxygen use in emergency ambulances and in a hospital Emergency Department. Emerg Med J 2008; 25: 733-736

Too much oxygen… Too much oxygen may cause 2,000-4,000 avoidable deaths per year in COPD flare ups (National COPD Audit 2003) Administration of high flow oxygen to COPD patients has been associated with increases in mortality, length of hospital stay, requirement for ventilation and admission to high dependency units (Austin 2010) In 2009, 281 serious incidents involving poor oxygen management, resulting in 9 deaths (NPSA 2009) Oxygen toxicity leads to acidotic, hypercapnic respiratory failure that may require Acute NIV or intubation and ventilation, both of which lead to increased use of resources and longer length of stay (Austin 2010)

SECAMB NHS TRUST Introduced the 6 minute cycle for emergency oxygen prescribing Reduced rates of NIPPV by 26% in pilot phase

Add tasmania paper and the others – thorax on top

East of England SCN Lianne Jongpierre Daryl Freeman Who was involved? EEAST staff Robert Isherwood Dale Gedge East of England SCN Lianne Jongpierre Daryl Freeman Can we get a picture of Andy in too – am sure you have thought of that

East of England

What did we do? We reviewed and adapted the initial 6 minute cycle from South East Coast using senior members of EEAST We devised an algorithm & 10 top tips which fits into their work trouser pockets We piloted it in West Norfolk

10 Top Tips

Oxygen prescribing algorithm

Effects of Change DF attended a meeting to discuss wider roll out of the project into Norfolk Pilot in West Norfolk had been positively received by Ambulance Crews A decision was made following that meeting to disseminate the 6 minute cycle to the whole of the EEAST area ( 5 counties)

Conclusion The SCN will disseminate the educational material beyond EEAST Oxygen champions in secondary care Primary Care Community Hospitals There have been good & bad aspects of this project GOOD Collaboration between both organisations Adoption of 6 minute cycle BAD Poor engagement from senior staff within EEAST owing to operational difficulties No chance to evaluate as no comparison sites once adopted across the Trust

Questions? daryl@doctors.org.uk