Monitoring domiciliary oxygen therapy in adults

Monitoring is vital for all patients prescribed domiciliary oxygen therapy to ensure treatment:

• is still indicated (38% of patients who meet the criteria for domiciliary oxygen therapy when discharged from hospital no longer had a clinical requirement for therapy at follow-up 4 to 8 weeks later)
• is being effectively adhered to.

Domiciliary oxygen therapy is often prescribed before discharge from hospital; however, there is no evidence to support this practice. If prescribed on discharge, clinicians must emphasise that it is short-term therapy and timely follow-up is especially important.

Specialist review is needed for ongoing domiciliary oxygen therapy within 4 months of starting therapy when the patient is stable; do not assess the patient if they are unstable in order to avoid inappropriately continuing long-term oxygen therapy. Review includes repeat arterial blood gas analysis on room air to assess ongoing need for oxygen therapy, and pulse oximetry to assess adequacy of oxygen delivery. Also assess smoking status and impact of domiciliary oxygen therapy on patient’s quality of life.

Patients are reviewed annually thereafter, or more frequently if the patients’ condition warrants it. Annual review may involve the general practitioner or specialist.

Incorporate patient education into assessments to help maximise the patient’s understanding and adherence, and the effectiveness of domiciliary oxygen therapy. Comprehensive patient education material on domiciliary oxygen therapy is available from the Lung Foundation Australia website.

If domiciliary oxygen therapy is no longer needed, explain to the patient that this is because they have responded well to therapy; telling the patient they are no longer eligible for funding may cause anxiety.