Perceptions of Individuals With Chronic Lung Disease on Home Use of Pulse Oximetry.

BACKGROUND: Pulse oximeters are often used at home by patients with chronic respiratory diseases and more recently for remote monitoring of patients with COVID-19. There are no published data outside a supervised telemedicine setting regarding patients' experiences with these devices. Our objective was to explore patients' usage patterns and perceptions of using pulse oximetry at home. METHODS: Patients with chronic respiratory disease who had a pulse oximeter at home were recruited to complete a structured survey. RESULTS: Thirty participants with a range of chronic respiratory diseases (mean age 71 y, 16 females) were recruited. Most participants (83%) used home oxygen therapy. Pulse oximeters were bought online (46.7%), at a pharmacy (40%), at a medical equipment store (6.7%), through a clinic (3.3%), or from an oxygen supplier (3.3%). Use was self-initiated in 56.7% of cases and was based on a health care-related recommendation in 26.7% of cases. Sixty percent of participants used the oximeter daily, with 90% expressing confidence in interpreting their oximeter readings primarily due to education from health care professionals and in-patient experiences. Almost all participants adjusted their activity levels or management based upon oximeter readings. Most participants reported that using a pulse oximeter at home was helpful in judging their physical limitations and provided reassurance and confidence in their disease management. CONCLUSIONS: Subjects appeared confident in their use of home pulse oximetry. Health professionals should identify patients who use pulse oximeters for monitoring and ensure that they are able to interpret readings correctly and, if appropriate, adjust management safely.

Improving access to ward-based respiratory failure management: a case study in the development of a respiratory care unit at an Australian metropolitan health service.

This case study describes the implementation of a ward-based respiratory care unit to improve access to specialised respiratory failure management at an Australian metropolitan health service. Using a case study approach, we describe the conception, development and implementation of a respiratory care unit within a previously inexperienced ward. Key barriers and facilitators are explored and the importance of a safety culture and an aspiration for continuous quality improvement are detailed. Three key aspects of implementation were identified: physical environment, expertise and governance. Continuous review of clinical and quality data was also considered critical to success. Stakeholder engagement was identified as both a barrier and facilitator to successful implementation. Early success was demonstrated through increased utilisation of respiratory interventions but with less utilisation of the intensive care unit and no apparent deterioration in clinical outcomes. Successful implementation of ward-based management of respiratory failure can be undertaken within non-tertiary settings but requires a comprehensive plan. Essential aspects include the support of clinical champions, early and continuous stakeholder engagement and an aspirational culture of safety and continuous quality improvement.What is known about the topic?Non-invasive ventilation and high-flow oxygen therapy are now established as key treatments in the management of acute respiratory failure. Access to these treatments is often limited to critical care locations (emergency department, intensive care unit (ICU) and operating theatre), but ward-based use can be safe and effective when applied with appropriate clinical policies, expertise and staffing.What does this paper add?This report describes the successful and rapid development of a specialised respiratory care unit within an inexperienced ward at an Australian metropolitan health service. Prior to development of the unit, the health service only provided non-invasive ventilation and high-flow oxygen therapy within critical care locations. Successful implementation was associated with increased utilisation of these therapies with significantly less ICU utilisation and no apparent deterioration in outcomes.What are the implications for practitioners?An explanation of a model for implementation is provided that may help health services improve access to complex respiratory failure management outside of critical care locations. Key factors in the success of the model are identified and examined.