Master in Quality & Safety 'Literature Review' chapter

  • Length: 14 pages
  • Sources: 20
  • Subject: Healthcare
  • Type: 'Literature Review' chapter
  • Paper: #5751190

Excerpt from 'Literature Review' chapter :

This particular aspect is what most medical trainers miss when dealing with interns or newly appointed nurses. They found that oxygen use, if below the necessary requirement can be damaging, so can its overuse. In another study, it has been found that using oxygen below the prescribed level can instigate damage in the organs, respiratory structures and can be especially damaging for patients who have chronic obstructive pulmonary disease (Danchin et al., 2009). Hence, the training and instructions that are given must follow be thorough enough to let the health caretakers realize that the monitoring is not merely a game of reading and recording, but it can have serious repercussions if handled carelessly.

Some of the common mistakes, which can be avoided through proper and accurate transference of instructions and training, occur in different medical circumstances. Sometimes nurses tend to miss the monitoring deadline. For instance, if a patient is required to have 80% of oxygen flow and saturation level, and overnight observations are not recorded, the patient could end up requiring intubation and ICU admission (O'Driscoll et al., 2008). Similarly, Cabello et al. (2009) found that no action had been taken on irregular saturation levels. They found that sometimes patients were required to have a certain level of oxygen saturation but during the monitoring session, the saturation levels recorded were higher than what was required. They warned that if this particular change is not properly reported to the doctor, the patient could experience a damaging or even fatal cardiac arrest. One implication from all these studies is that untrained and inexperienced professionals should not be handling oxygen use. Any exception to this rule, at any time, can turn out to be damaging for the patients.

Wilkinson et al. (2005) in their study reviewed oxygen toxicity and found that untrained individuals can make the mistake of using compressed air instead of oxygen in cylinders. This mistake, they found, can be made if careful observation is not made. Furthermore, in some cases this can lead to certain death for the patient. One implication for this study is that compressed air should never be used as an alternative for 100% oxygen. It has been noted that, from time to time, oxygen cylinders can be left empty or be kept on very low levels. This has to be monitored carefully so that complications in the respiratory structure can be prevented (Slagboom et al., 2005). One consequence from this study is that only trained professionals should be delegated with the responsibility of managing oxygen use.

Enarson et al. (2008) studied the use of new oxygen concentrator systems in district hospital paediatric wards throughout Malawi. They surveyed district hospitals and found that most of the paediatric wards did not have a proper oxygen use set up. However, a government program, namely, "Child Lung Health Programme," supplied oxygen concentrators and other essential apparatus to twenty two districts and three regional hospitals. After the integration of oxygen concentrators the researchers the trained the hospital staff on how to use and maintain it. This was done after developing a curriculum. The researchers found that monitoring the oxygen supply apparatus is a very delicate process and only trained professionals are suitable to handle and maintain the use of oxygen equipment in hospital wards. The writer agrees with the conclusions of this study and argues that oxygen use protocols ought to be developed in all healthcare institutes in order to minimize the misuse of apparatus.

Theme 3: The impact of high-level monitoring processes

For this section, seven articles have been selected and reviewed. Researchers found that if and when oxygen saturation levels rise above or falls below the prescribed level, it can result in fatal damages for the patients. Every treatment has its benefits and risks, so does oxygen use, hence it needs to be monitored carefully.

Longphire et al. (2007) in their study reveal that oxygen is a drug that can save lives. Unlike oxygen, other life-saving drugs are used with prescriptions, which specify the specific dose required. They argue that oxygen use should always be administered with specific protocols. One implication of this study is the judicious use of oxygen in hospital wards with strict protocols.

Oxygen use protocols should include not just the dose required by individual patients, but also the precise time and date. Furthermore, protocols should also be established with regards to how the oxygen dose should be measured since different measuring devises have different strengths and procedures (Dias et al., 2008). Furthermore, in a similar study, Ukholkina et al. (2005) claim that only properly trained staff are suitable to administer oxygen use. They argue that oxygen apparatus is not simple enough to be used by any nurse. Specific training is required to read the oxygen levels and give appropriate dose to each patient. The writer found that both studied implied that oxygen use is a complicated process with difficulties. Any mistake in its delivery can cause significant damage to the patients.

Bassand et al. (2007) reviewed the British Thoracic Society's fundamental guidelines along with need for the utilization of oxygen as a treatment and the relevant monitoring procedures that follow. He found that the report also signifies how carelessness on following the saturation levels can lead to serious complications for the patients. In some states, oxygen use is a prescription drug and failure to monitor oxygen levels can lead to a criminal offense. Therefore, those assigned with the duty of monitoring oxygen levels have got to be vigilant not only to avoid any harm to the patient but also to avoid any lawsuits.

Other researchers state that the least amount of prescribed oxygen, with regards to the patient's disease, must be given. For instance, Lima and colleagues (2009) focused on the use and benefits of regular examinations of the oxygen saturation (StO2) for clinically ill patients. They found that the direction and use of the prescription of oxygen use has to precise and clear so that those responsible for its application can mirror it without any complications Oxygen application at wards has always been a complicated process. Almost all in-patients receive oxygen at some point in their recovery process. However, quite often delivery of oxygen is carried out without any protocols.

Researchers from other study found that going below the prescribed oxygen use is not as damaging as exceeding it. They also found that the use of oxygen must be for the shortest time period as well so that the extended use does not raise complications either. This particular fact, the researchers further add, is essential for patients who have chronic obstructive pulmonary disease (COPD), or those who have decreased hypoxic metabolism with minimal carbon dioxide maintenance. The researchers further reveal that the acute asthma patients could experience difficulties and complications in carbon dioxide exclusion is they are prescribed 100% oxygen saturation, even if it is over a short period of time (Agarwal et al., 2008). One implication of this study is that the physicians should be cautious when they are adjusting the oxygen flow. Any increase or decrease in the flow can disrupt and harm the patient quite significantly.

Aandstad et al. (2006) focused on the damaging effects of overuse of oxygen on children. The reason that the researchers claim this is because high levels of oxygen can also prove to be damaging for tissues and cells in the respiratory structure and tract. The researchers also write that oxygen use in patients with damaged or diseased can also lead to serious and lethal complications as it can cause problems in breathing and eventually instigate chronic respiratory failure. Hence they claim that minimal use of oxygen and for the shortest time should be the first option for all doctors. There are two different aspects to this study. This study used children as subjects and therefore the results are pertinent to that population only. The second, and more important aspect, is whether these results can be used when adults are being treated. Additional research needs to be carried out to ascertain the findings in this area.

Sometimes artificial supply of oxygen, despite being monitored can be life-threatening for the patients. For instance, Robertson (2005) in his study compared the benefits of natural air versus 100% artificial oxygen for asphyxiated babies. The methodology he had employed had been a meta-analysis of research studies carried out in the past. He analysed both qualitative and quantitative studies published in online medical libraries. He found that exposure to 100% oxygen for new born babies, despite being monitored, is harmful. This study too used children as their subjects. It would be interesting to note whether these results also stand true for adults. Once again, the writer suggests that additional research needs to be carried out to ascertain the findings in this area.

Methods and methodologies

In the aforementioned section, the writer reviewed twenty one research studies carried out in the past five years. Two research studies had used the survey method as…

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