Authors (including presenting author) :
Lau WLC(1) on behalf of Respiratory SSG, M&G SG, OTCOC(2), HA
Affiliation :
(1) Department of Occupational Therapy, Kowloon Hospital
(2) Respiratory Sub-specialty Group, Medical & Geriatric Specialty Group in Occupational Therapy Coordinating Committee (OTCOC)
Introduction :
The Occupational Therapy Clinical Practice Guideline on Home Oxygen Therapy for Adult Patients has been developed since 2009 to guide the practice by Occupational Therapists in relevant service provision. There are nine essential steps being established for provision of home oxygen therapy service which are in line with the essence message as promulgated by the guideline: “The right patient receives the right amount of home oxygen for the right period of time”. Occupational Therapists are recommended to follow through these steps when handling home oxygen prescriptions in clinical practice. Under continuous quality improvement process for guideline development, the project team had initiated subsequent revisions in 2013 and 2016 with reference to the most updated evidence at the time of review. The first cross-cluster clinical audit for home oxygen therapy provision was conducted in 2012. The current project is the second cross-cluster clinical audit exercise. This clinical audit aims at evaluating the compliance of clinical practice by occupational therapists on home oxygen therapy installation and follow up arrangement through audit on e-documentation.
Objectives :
Primary Objectives:
-To evaluate utilization of e-documentation on HOT among OT
-To promote OTs’ compliance on clinical procedure on HOT arrangement
Secondary Objectives:
-To facilitate better communication and coordinated care for HOT through e-documentation
-To assess the changes in oxygen therapy regimes and flow-rates over time on HOT FU
-To enhance service quality on HOT through improvement in our existing practice
Methodology :
The electronic OT Discharge Summary (OTDS) indicated first installation of oxygen therapy and suffered from COPD, Asthma, Pneumoconiosis, Tuberculosis Chest or others with respiratory disease throughout HA during the period of 2017/10/1 till 2018/9/30 will be retrieved from CDARS for audit. Excluded those with “Cancer types of disease” & “Infant or Pediatric Conditions” as 1st Condition in OTDS. All targeted OTDS will be audited from EPR or CMS. The selected OTDS forms will be reviewed using the audit form based on audit criteria by Respiratory SSG members as independent auditor. Data will be analyzed to calculate the percentage of compliance for each criterion step. For the availability of HOT FU arrangement, search for the HOT Follow-up documentation information in the signed OTDS, OT Progress Note (OTPN) or ICDS home visit report in the consecutive period.
Result & Outcome :
Results: Total 138 cases from 14 HA hospitals in 7 clusters were recruited in the audit exercise. The 1st ranking diagnostic group was COPD 71%. The overall compliance rate for the audit criteria selected in this exercise was above 90%. Among all subjects, the most common documented regime was long term oxygen therapy (LTOT) 69%, followed by a smaller portion of 28% documented with short-term oxygen therapy (STOT) and only a rare amount of 3% was documented with palliative oxygen therapy (POT). Upon further evaluation, different means of HOT follow-up arrangement was recorded: 39% COT, 28% Phone, 9% CGAS, 8% OT-OPD and 4% ICDS. 12% of the e-documentations did not specify mode of follow-up arrangement. No follow-up arrangement and refusal was recorded in 7% and 2% of e-documentations respectively. Finally, 63% subjects were being followed up successfully. 37% subjects failed to be followed up due to 9% documented no follow-up arrangement, 14% re-admission or death before the follow-up schedule, 12% pending follow-up and 2% refusal. Among the successful follow up cases, 38% and 33% of the subjects were indicated to change in their oxygen regimes and flow-rates respectively.
Conclusions: The audit exercise indicated a high compliance rate of OT on the clinical procedures as described in HOT clinical practice guideline. There was relatively high percentage of the cases had indication to change their O2 regimes and flow-rates during HOT follow up. It proved the importance and needs of post-discharge HOT follow up service. To review on local practice for enhancement of the collaboration with community team or ambulatory care such as ICDS, CGAS, COT and OT-OPD to facilitate a better continuity care to patients was suggested. Furthermore, the utilization of e-documentation for HOT service has potential to improve service quality through unified documentation format and clinical terminologies for better communication and care coordination. Therefore, continuous education and promotion on the HOT clinical practice guideline were suggested.
