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Introducing oxygen-wristbands to a clinical setting

A budget-conscious innovation for improving patient care

Wednesday, May 30, 2018

Four years ago, front-line clinicians at Derby Teaching Hospitals NHS Foundation Trust developed a system of colour-coded silicone wristbands which stated the patient’s target saturation range, designed to ensure the correct level of oxygen was prescribed.

 

Since featuring the oxygen-wristband pilot with Dr Gillian Lowrey in 2016, Respiratory Futures has seen a high number of enquiries about the project. We’ve been back in touch with Gill to find out what’s happened since.

Gill, welcome back to Respiratory Futures. Can you recap on why the wristbands were developed and how they are being used in clinic?

We developed the oxygen wristbands after the introduction of electronic prescribing at the Royal Derby Hospital. The paper prescription chart was accessible at the end of the patient's bed, allowing the supervisor doing observations to review the target saturation, however once the electronic system was put in place the assistant could not easily access the target saturation. 

Two out of the three pilot sites showed prescription and titration of oxygen improved from 64% to 98% and 76% to 94%.

The wristbands provide an easily accessible, visual prompt for staff about a patient’s target saturation whilst in hospital. The bands are colour-coded to help them titrate oxygen to the correct range, limiting oxygen toxicity but also under oxygenation, both of which can cause harm to patients.

We mostly use them for inpatients, but also for some of the outpatients such as those on domicilary NIV or who are known by the home oxygen team to have hypercapnic respiratory failure.

Last time we talked you told us the response to the pilot from patients and clinicians was really positive. How have results continued since?

To recap on the results from the 2015/16 pilot, two out of the three sites showed prescription and titration of oxygen improved from 64% to 98% and 76% to 94%. Feedback from staff was also positive; the staff surveys from the pilot sites found that 86% felt the wristbands had benefitted to patient care.

I continue to get anecdotal reports and positive feedback from other sites that have introduced the wristbands. However, keeping up the momentum is the hardest thing – everyone starts off being enthusiastic but embedding this in everyday practice is hard. So this is a work in progress for me and I would love to hear if anyone has advice to share in how to achieve this. 

Investment for the wristbands comes out of ward budgets. This is not ideal, but the cost is similar to that of dressings and oxygen masks.

Since the article on Respiratory Futures in 2016, what sort of response have you received from readers?

Since the article 2 years ago, I have had many people contacting me – both in the UK and abroad, including Italy, Australia and South America! Occasionally someone finds the article and tweets it, resulting in a new flurry of interest. But even though it’s been two years I still receive regular email interest from UK based HCPs.

I think this demonstrates the value and accessibility of Respiratory Futures as a digital platform – you can tap into a wealth of respiratory information regardless of where you are working. It encourages collaboration and knowledge sharing so that efforts aren’t duplicated, which is fantastic.

Many enquiries are about where we got the bands from which is easy to answer – any commercial company that makes promotional items will usually be able to make silicon wristbands. A simple Google search of 'silicon wristbands' will show suppliers.

Similarly, the cost of the bands is something a lot of people ask about. At the moment we pay about 14p per band, but the more you order the cheaper they are. 

People also are interested in the staff training and how we rolled the project out - our presentation for this is available in the Respiratory Futures Resources area

When introducing the wristbands the most important thing is to go through local governance procedures. Make sure similar wristbands for other things are not already being used.

How far has the pilot been rolled out into general care now? And how can people introduce the oxygen wristbands into their own clinics?

We now have the wristbands in all inpatient areas, but it is still a work in progress. We have tried to reinforce use more consistently by putting a check box for wristband on the oxygen prescription. 

Budget-wise, investment for the wristbands comes out of ward budgets. This is not ideal, but the cost is similar to that of dressings and oxygen masks. As a guide, for our busy respiratory wards the costs add up to about £300 per year, per ward. We believe we save that in oxygen-use as patients tend to wean quicker. All in all, they are a low-cost solution to a prevalent problem in oxygen-use in an acute setting.

What should people be aware of before deciding to introduce the wristbands in their clinic?

In terms of best practice, when introducing the wristbands the most important thing is to go through local governance procedures. Make sure similar wristbands for other things are not already being used – if they are, it’s important to ensure the colours used are different and everyone is aware of their purpose.

Training staff can be time consuming, but we established a network of champions which worked really well in disseminating knowledge. We also now have a e-training package for nurses, and I have to say, training the ward nursing staff was the best use of our time.

Thank you for joining us Gill.

Dr Gillian Lowrey is a Respiratory Consultant Physician at Derby Teaching Hospitals NHS Foundation Trust. Follow her on Twitter: @GillianLowrey

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