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Royal United Hospitals Bath NHS Foundation Trust
Great Western Hospitals NHS Foundation Trust
Salisbury NHS Foundation Trust
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 Formulary Chapter 3: Respiratory system - Full Chapter
Notes:

Respiratory-related Prescribing Guidance

Please see our Prescribing Guidelines page for all prescribing guidance relating to this chapter.

Respiratory-related Shared Care Agreements

Please see our Shared Care Agreements page for all shared care agreements (SCAs) relating to this chapter.

National guidance - The Respiratory Chapter should be read in conjunction with BTS guidelines , BTS/SIGN Asthma Guidelines  and NICE guidelines on COPD and Asthma

Guidance on inhaler devices 

Inhalers should always be prescribed by their BRAND name. 

The patient's ability to use a device should be assessed by a competent healthcare professional and re-assessed as part of structured clinical review. If the patient is unable to use a device satisfactorily, an alternative should be found.

RightBreathe is a free app/website designed to help clinicians and patients use inhaled therapy and devices appropriately https://www.rightbreathe.com/. Asthma.org has patient-friendly videos of inhaler technique here.

In children aged 0-5 years, pMDI and spacer are the preferred delivery method for β2 agonists or inhaled steroids. A face mask is required until the child can breathe reproducibly using the spacer mouthpiece. 

Self-care

Many of the products in this chapter are available for purchase over-the-counter, and patients are encouraged to self-care, with the support of their community pharmacist, in the first instance. For further information on self-care & the NHS, please refer to https://www.england.nhs.uk/medicines/conditions-for-which-over-the-counter-items-should-not-routinely-be-prescribed/

Chapter Links...
 Details...
03.06  Expand sub section  Oxygen
 note 

NEW 03/04/2020 Use of Oxygen in

COVID-19 patients/palliative - Key Messages

There has been no specific information published about the use of oxygen for

patients in primary care with suspected COVID-19.

Therefore current provision of oxygen is as per current arrangements

(using a Part A HOOF on https://www.airliquidehomehealth.co.uk/hcp/HOOFA )

and criteria for use.

BTS guidance should be followed.

  • The BSW Primary Care model and guide during COVID-19 (Patient aged >12) states that if a patient with suspected COVID-19 would not benefit from

          admission to hospital that the GP can consider Palliative Care/ Home Oxygen

if available & appropriate. GPs should be mindful of oxygen supplies and that

          oxygen providers might struggle with demands during this crisis.

  • Only institute a home oxygen prescription for patients who are hypoxic
  • (sats ≤ 92%), rather than simply those with breathlessness who are not necessarily hypoxic.
  • All patients should be given appropriate ‘just in case’ meds (e.g. opiates),
  • which may well control their symptoms better than oxygen, even in hypoxic patients. See COVID-19 palliative care guidance
  • Local COPD guidance found here; p5 for oxygen information.

Wiltshire Health & Care:

  • WH&C staff are only visiting home oxygen patients who are unstable.
  • All stable patients have had their time to the next visit extended.
  • WH&C are reviewing all their oxygen patients virtually & removing oxygen
  • from those considered “non-essential” to help preserve supplies.

BaNES CCG:

  • GPs should liaise with the BaNES IMPACT team as usual for all oxygen
  • requests.

SFT Respiratory clinic (oxygen):

  • No face to face oxygen clinic currently running (no routine patients).
  • Telephone advice still available. Patients would be seen if clinically urgent
  • but would need to come into the hospital. Dealt with on a case by case basis.

Swindon CCG:

  • Routine reviews are not currently happening. Advice can be sought from
  • the team for acute problems.

Contacts for oxygen referrals:

BaNES – IMPACT team BATHNES.impactservice@virgincare.co.uk 01225 831 808

Swindon – Community COPD team

gwh.communitycopdoxygenspecialistservices@nhs.net 01793 646436

South Wiltshire

http://www.mg.salisbury.nhs.uk/media/1719/oxygenservicereferral.doc to the

resp. dept. at SFT

North, East and West Wiltshire – referral forms:

https://prescribing.wiltshireccg.nhs.uk/?wpdmdl=653 to Wiltshire

Health and Care community respiratory team GWH.WiltsO2@nhs.net

01249 456607

 

SECONDARY CARE ONLY

 MHRA Alert - important information about High flow Oxygen therapy devices

(including wall CPAP and high flow face mask or nasal oxygen) during COVID-19 epidemic 

 ---------------------------------------------

General Information around prescribing OXYGEN

Home oxygen comes in many forms. Used appropriately it can improve mortality

in selected patients. However, it is often overprescribed and can pose a fire risk to

patients and those around them if used incorrectly.

Home oxygen should not be used to treat acute hypoxia or acute on chronic hypoxia.

If home oxygen does need to be prescribed you will need to complete a Part A Home Oxygen Order Form (HOOF) that will allow a temporary supply of oxygen to be

installed prior to a formal assessment by the community Home Oxygen Assessment Service.

When completing a Part A HOOF you will be asked what type of oxygen equipment

you require:

  • Concentrator or static cylinder
  • Flow rate required (in litres per minute) – this should be maximum 2 litres
  • per minute
  • Expected usage (in hours/day) – this should be maximum 16 hours per day
  • Consumables required (nasal cannulae or mask) – usually nasal cannulae

When completing a Part A HOOF you will also be asked how quickly you need the

oxygen equipment installed. It is costly to request an urgent (ie 4 hours) installation

so please order ‘next day’ or ‘standard’ installation (ie 3 days).

Please check the patient has someone available to let the provider in to their home to install the oxygen equipment.

The Part A portal can be accessed using: https://www.airliquidehomehealth.co.uk/hcp/portal_a/  The webpage includes a

detailed guide on how to complete the Part A HOOF.

No password is required to complete a Part A HOOF.

Remember - Home oxygen is a fire risk, both to those who use it and to those

who live nearby. Patients who smoke, or have relatives who live with them and

smoke, should not be given home oxygen unless agreed after a detailed

multidisciplinary risk assessment has taken place.

 

 ....
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG
Blueteq
High Cost Drug Approval System

Traffic Light Status Information

Status Description

Traffic LightRed

RED - Hospital only to be prescribed by a specialist and supplied from secondary care ONLY throughout treatment.  

Traffic LightAmber

Amber medicines are considered suitable for GP prescribing following specialist initiation or recommendation.  

Traffic LightAmber with Shared Care

Shared Care - these medicines require specialist initiation and stabilisation. Ongoing division of responsibility for drug and disease monitoring between specialist and GP by a Shared Care Guideline (SCG). If no SCG in place status reverts to red.  

Traffic LightGreen

These medicines are appropriate for initiation in both primary and secondary care. Prescribing is appropriate within licensed or local recommendations.  

Traffic LightSelf

Suitable for patient to be directed to buy themselves  

Traffic LightGrey

Not currently used. We intend to include this TLS in future to highlight where a decision to use this medicine is under review.   

Traffic LightBlack

(In use from Oct 2020) Used where a decision has been made by the BSW APC not to routinely commission this preparation for its licensed indications. Do not prescribe.   

Traffic LightRed Specialist Centre

Not currently used. We intend to include this TLS in future to highlight where this medicine and indication is ONLY available through a Specialist Centre according to a NICE Highly Specialised Technology or NHSE Specialised Commission Circular / Policy.  

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