1. 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

2. 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:

3. 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)

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

5. Add tasmania paper and the others – thorax on top

6. 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

7. East of England

8. 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

9. 10 Top Tips

10. Oxygen prescribing algorithm

11. 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)

12. 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

13. Questions?