Fundamentals of Oxygen Safety and Management in Home Care and Hospice

presented by Bryan Beatty, RRT, CPFT

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Financial: Bryan Beatty receives compensation from MedBridge for this course. There is no financial interest beyond the production of this course.

Non-Financial: Bryan Beatty has no competing non-financial interests or relationships with regard to the content presented in this course.

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Video Runtime: 28 Minutes; Learning Assessment Time: 12 Minutes

Oxygen therapy is frequently prescribed for patients in home care and hospice. The Centers for Medicare and Medicaid Services (CMS) defines oxygen as a drug and therefore requires a prescription for its administration. The most frequent use of oxygen is for treatment of dyspnea in older adults with chronic obstructive and restrictive pulmonary disease. In 1995, the number of people using long-term oxygen therapy (LTOT) was estimated to be 800,000, at a cost of $1.1 billion. In 2011, CMS implemented a competitive bidding process to reduce the cost of oxygen therapy. This policy change was effective in lowering cost but limited the availability of certain modalities. Despite a growing number of people diagnosed with chronic obstructive pulmonary Disease (COPD), the cost has still risen, but only to $1.4 billion. This foundational course will address care and management of patients receiving oxygen therapy at home and the related safety considerations. Home care and hospice are physician-directed models of care. Like all aspects of Medicare, there are specific coverage guidelines and criteria for LTOT. Indications for usage, goals of therapy, delivery methods, safety concerns, and oxygen's use in home environments of care will be addressed. A patient case scenario with best practices will be used to illustrate care and management of a patient with COPD. This course is directed toward those practicing in-home care and hospice at home. It is interdisciplinary--intended for nurses, occupational therapists, physical therapists, respiratory therapists, social workers, and speech-language pathologists.

Meet Your Instructor

Bryan Beatty, RRT, CPFT

Bryan Beatty, RRT, CPFT is the clinical program manager at the University of Louisville, Pulmonary Division. He is a clinical researcher and a respiratory therapist, managing a full-service pulmonary function lab and occupational health program. He has been involved in research and education for 35 years. He has been a long-standing American Lung Association volunteer,…

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1. Long-Term Oxygen Therapy and CMS Criteria

Long-term oxygen therapy (LTOT) has been a critical part of home care for patients with chronic lung disease since the 1970s. The current oxygen guidelines from the Center for Medicare and Medicaid Services (CMS) are based on the arterial oxygen levels in the blood. To receive LTOT at home, a patient must have an arterial partial pressure of oxygen (Pa02) at or below 55 mmHg or arterial oxygen saturation (Sp02) < 88%. Once a patient qualifies, then comes the decision on equipment and what fits the needs of the patient. This decision is crucial due to the 60-month CMS contract for LTOT coverage.

2. Delivery Devices: Advantages and Disadvantages

Home oxygen therapy may be delivered by the following methods: compressed gas, liquid oxygen, and oxygen concentrators. Each of these methods has advantages and disadvantages. The newest modality, portable oxygen concentrators (POC), offers smaller, less intrusive options for LTOT but have limitations that are often overlooked. Additionally, this chapter will cover the effect of CMS policy on the availability of liquid oxygen (LOX).

3. Oxygen Therapy: Meeting the Patient’s Oxygen Needs

The goal of oxygen therapy is to maintain Sp02 levels at an optimal level. To achieve this you must measure Sp02 at rest and with activity. During this chapter, I will present a brief case study detailing the obstacles that may be encountered as the patient’s needs change and the options available to address those obstacles.

4. Safe Administration of Oxygen Therapy in Home Care and Hospice

Oxygen is a combustible, nonflammable element. The idea that you will cause an explosion with oxygen is a myth that is perpetuated in movies and television. However, oxygen will fuel a fire and can cause horrific burns when not used correctly. The most common safety issue associated with oxygen therapy is a patient who continues to smoke. There are other safety issues associated with home oxygen therapy that will be addressed in this chapter.

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