Home Oxygen
Service Assessment and
Review (HOS-AR)
Janice Quarton
Advanced Nurse Specialist
Respiratory Medicine
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What is HOS-AR?
• Provision of a systematic integrated oxygen
service
• Provision of easy access to assessment
and follow up procedures via appropriately
qualified and trained healthcare
professionals using appropriate diagnostic
equipment
2
What is HOS-AR?
• Reduce/eliminate waste and poor quality
care, strengthen affordability and value,
through targeting the service on those who
will benefit from home oxygen
• Ensure a higher standard of clinical
treatment and improved outcomes,
through more effective and speedier
diagnosis
• Provide the users with a positive
experience of care
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Why Do We Need It?
• Oxygen service review in 2010 identified
85,000 patients in England on oxygen at a
cost to the NHS of £110 million a year
• Between 24 and 43% of oxygen
prescribed is either not used or does not
give any clinical benefit
• Oxygen is charged for each patient
whether used or not
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Aim of HOS-AR
• Have quality at its core i.e. be accessible,
safe and responsive to patients
• Be evidenced based, clinically led and
continually strive to improve outcomes for
patients
• Be affordable and represent good value
for money
5
Change in Oxygen Contracts
• May 2012 new oxygen contracts came into
use and changes in access to HOOFs
occurred
• Non specialists can only access limited
oxygen equipment via HOOF A
• Specialists now have responsibility for
choosing the equipment for the patients
• A change in the way charges are applied
was introduced
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Local HOS-AR
• Meetings between CCG and secondary
care to develop service specifications
• Agree referral pathways
• Develop referral proforma
• Recruit appropriately trained nurses to
deliver service
• Develop a service operational policy
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Local HOS-AR
• Provide education to both primary and
secondary healthcare professionals
regarding the role of oxygen and the
service
• Organise locations across the CCG for
provision of assessment
• Develop an effective and active register of
all oxygen patients identifying areas for
review and ongoing assessment
8
Local HOS-AR Inclusion/Exclusion
• Inclusion
– Adult patients with oxygen saturations ≤92%
breathing air
– Patient is clinically optimised in primary care
– Treatment for end of life care if patient is
hypoxaemic
– Completed referral form
9
Local HOS-AR Inclusion/Exclusion
• Exclusion
– Patients under 18 years
– A non-hypoxaemic breathless patient
– SpO2 >92%
– Patients that smoke
– Patients who have not been clinically stable
for 6 weeks
– The above may not be an exhaustive list anad
consideration will be given in individual
circumstances
10
Key Messages
• Oxygen is not a treatment for
breathlessness
• Do not issue oxygen when resting SpO2 is
>92%
• Refer patients to the HOS-AR team for
assessment
– Therapeutic oxygen via Choose and Book
– Palliative oxygen via clinician to clinician
discussion and faxed referral form
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