Playing It Safe

As a longtime registered respiratory therapist who is now an associate of The Corridor Group, a home medical equipment consulting firm based in Overland Park, Kan., Tim Hogan has kept a keen eye on the long-term oxygen therapy market. In doing so, he’s heard some horror stories from oxygen providers:

An oxygen patient died from burns suffered when her hair caught on fire as her attendant brushed her hair, then sprayed it with hair spray while the patient wore her cannula;

A portable oxygen cylinder, propelled by the heat build-up in a closed, parked car, took off like a rocket. Heat caused the cylinder’s safety relief valves to activate, and it shot through the car’s back window;

A woman wearing her cannula was severely burned when grease from the bacon she was cooking on her electric grill splattered and melted the cannula to her face.

All too often, Hogan says, the headlines identify oxygen-related fires in the home. He also notes last year’s Houston tragedy when, according to news reports, a bus carrying elderly nursing home residents away from Hurricane Rita caught fire and passengers’ oxygen tanks exploded. Twenty-four of the evacuees were killed.

Such horrendous events underscore the need for providers to place an emphasis on oxygen safety, Hogan says.

“We have to discuss safety with the patient,” he says. “We have to provide them with written and verbal [instructions].”

Safety tips aren’t just for the patient’s protection, although that is foremost, says Hogan, especially now that the Deficit Reduction Act transfers equipment ownership to Medicare oxygen beneficiaries after 36 months. “It’s incumbent upon business owners to limit their liability,” he says.

Here are some of Hogan’s safety tips for oxygen therapy users:

• “No smoking” guidelines should be enforced. Patients who smoke must not smoke or light up while wearing oxygen and should be at least 10 feet away from the oxygen equipment when they do smoke. They should never smoke in bed, with or without oxygen.
• Do not use oxygen with facial oils or lotions that are petroleum-based (such as Vaseline). Use only water-based creams and lotions.
• Keep equipment away from obvious heat sources such as a radiator, fireplace, hot water heater, etc.
• Set up oxygen equipment in an area with good ventilation. Don’t store oxygen cylinders in closets or closed vehicles, such as the trunk of a car or in the car without the windows being cracked.

Also, don’t leave them leaning against a wall or in an area such as a hallway where they could easily be tipped over. Use an appropriate device to store oxygen cylinders in the home.

• Don’t use aerosol sprays such as hair spray while using oxygen.
• Do not use oxygen while cooking directly over a burner, stove or grill (even electric skillets or grills).

Hogan has some ideas for providers, too. “The organization has to establish a culture of oxygen safety,” he says, “and that starts with the person at the top. They have to realize it’s important.”

That means, he says, that staff must receive good safety training. And every time anyone from the organization goes to a patient’s home, he or she should be assessing oxygen safety, Hogan says. “They should be aware of how many tanks [the patient has]. If they only see one [but the patient] should have three, ask where the others are.”

You may find that they are stored properly in the bedroom, Hogan says. On the other hand, you might learn that they are in the garage next to the hot water heater — and that discovery could help you avert a potential tragedy.

It’s important, Hogan says, to reiterate the oxygen usage and safety guidelines to patients, their family members and caregivers. And if they repeatedly refuse to adhere to them? Hogan has advised providers serving such patients to caution those customers they will need to find another provider.

Raise Awareness Among Patients — And Employees

Awareness of and attention to the safety hazards of long-term oxygen therapy and oxygen use in general can help to assure safety and quality care, says consultant Tim Hogan.

At the time of oxygen delivery, for example, it may be assumed that patients and caregivers already know the dangers of oxygen use, so safety issues may be covered only briefly. Or, the patient and his or her family members often may not read the written safety instructions they are given.

According to Hogan, each time a representative of your HME company (this means any employee) goes into a patient’s home for any reason, it is an opportunity to assess both the environment and the patient for three important issues:

1. Compliance with the most recent physician’s orders;
2. Compliance with basic cleaning and infection control instructions/guidelines; and
3. Compliance with basic safety instructions, including basic oxygen safety guidelines.

In most cases, Hogan says, such assessments shouldn’t add more time to the visit or slow down the day; employees simply need to keep their eyes open. For example, is the patient using the prescribed flow rate? Are tanks stored in the closet?

“Technicians and therapists should be expected to take off the horse blinders when they knock on the patient’s front door,” Hogan says. “They need to break away from thinking that ‘I’m just here to deliver these supplies,’ or, ‘I’m just here to check on your machine.’”

He advises looking for risk factors among oxygen patients such as:

• Those who live alone or those with cognitive impairment;
• Patients who smoke;
• Non-working smoke detectors or no smoke detectors in the home; and
• Flammable clothing.

If technicians, therapists or other staff members do identify a non-compliance issue, Hogan says, the patient should be reminded and/or reinstructed on oxygen safety issues. A summary of the situation and the reinstruct should then be documented in the patient’s record per company policy.