Understanding Clinicians' Perceived Barriers and Facilitators to Optimal Use of Acute Oxygen Therapy in Adults

Joyce L Cousins; Peter A B Wark; Sarah A Hiles; Vanessa M McDonald

doi:10.2147/COPD.S263696

Understanding Clinicians' Perceived Barriers and Facilitators to Optimal Use of Acute Oxygen Therapy in Adults

Int J Chron Obstruct Pulmon Dis. 2020 Sep 25:15:2275-2287. doi: 10.2147/COPD.S263696. eCollection 2020.

Authors

Joyce L Cousins^{1

2

3}, Peter A B Wark^{3

4}, Sarah A Hiles^{1

3}, Vanessa M McDonald^{1

3

4}

Affiliations

¹ School of Nursing and Midwifery, University of Newcastle, Newcastle, NSW, Australia.
² Faculty of Nursing, Avondale University College, Sydney, NSW, Australia.
³ Centre of Excellence in Severe Asthma & Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia.
⁴ Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW, Australia.

Abstract

Background: Supplemental oxygen is commonly administered to patients in acute care. It may cause harm when used inappropriately. Guidelines recommend prescription of acute oxygen, yet adherence is poor. We aimed to identify barriers and facilitators to practicing in accordance with the evidence-based Thoracic Society of Australia and New Zealand (TSANZ) oxygen guideline, and to determine the beliefs and attitudes relating to acute oxygen therapy.

Methods: A national cross-sectional survey was conducted. The survey consisted of 3 sections: (1) introduction and participant characteristics; (2) opinion/beliefs, knowledge and actions about oxygen therapy and other drugs; and (3) barriers and facilitators to use of the TSANZ guideline. Convenience sampling was employed. A paper-based survey was distributed at the TSANZ Annual Scientific Meeting. An online survey was emailed to the TSANZ membership and to John Hunter Hospital's clinical staff.

Results: Responses were received from 133 clinicians: 52.6% nurses, 30.1% doctors, and 17.3% other clinicians. Over a third (37.7%) were unaware/unsure of the oxygen guideline's existence. Most (79.8%) believe that oxygen is a drug and should be treated as one. Most (92.4%) stated they only administered it based on clinical need. For four hypothetical cases, there was only one where the majority of participants identified the optimal oxygen saturation. A number of barriers and facilitators were identified when asked about practicing in accordance with the TSANZ guideline. Lack of oxygen equipment, getting doctors to prescribe oxygen and oxygen being treated differently to other drugs were seen as barriers. The guideline itself and multiple clinician characteristics were considered facilitators.

Conclusion: There is discordance between clinicians' beliefs and actions regarding the administration of oxygen therapy and knowledge gaps about optimal oxygen therapy in acute care. Identified barriers and facilitators should be considered when developing evidence-based guidelines to improve dissemination and knowledge exchange.

Keywords: COPD; acute oxygen therapy; prescription.

MeSH terms

Adult
Attitude of Health Personnel
Australia
Communication Barriers*
Cross-Sectional Studies
Guideline Adherence*
Health Knowledge, Attitudes, Practice
Humans
New Zealand
Nurse Clinicians / psychology
Nurse Clinicians / statistics & numerical data
Oxygen Inhalation Therapy* / methods
Oxygen Inhalation Therapy* / psychology
Oxygen Inhalation Therapy* / standards
Physicians / psychology
Physicians / statistics & numerical data
Practice Guidelines as Topic*
Practice Patterns, Physicians' / standards
Pulmonary Disease, Chronic Obstructive / therapy*
Social Facilitation*