Oxygen on Arrival: An Audit of Prescription Practices in the Emergency Assessment Unit

Abstract

Introduction Oxygen is a routinely administered, yet prescription-only therapy in hospital settings. Inappropriate prescribing can result in significant harm, particularly in patients at risk of type 2 respiratory failure. This audit aimed to evaluate adherence to guidelines on oxygen prescribing during admission clerking in the Emergency Assessment Unit (EAU) of Salford Royal NHS Foundation Trust, a UK tertiary care hospital. Methods A retrospective review of 100 consecutive patients admitted to the EAU over one month was conducted. Data were collected on oxygen prescription at initial clerking and throughout inpatient stay. A supplementary questionnaire assessed junior doctors' confidence and barriers related to oxygen prescribing. Results Only 45% (45) of patients had oxygen prescribed at initial clerking, with a further 26% (26) prescribed later. However, 29 (29%) never received a documented oxygen prescription. Among 19 chronic obstructive pulmonary disease (COPD) patients, eight (42%) were never prescribed oxygen. Errors were found in four (9%) of prescriptions, and out-of-hours admissions were associated with higher omission rates. Of 11 junior doctor respondents, nine (82%) reported lacking formal training on oxygen prescribing, and six (55%) felt the current system did not support safe practice. Conclusion Oxygen prescribing during acute admissions remains suboptimal. Gaps in documentation, clinical oversight, and training-especially out of hours-contribute to non-compliance with standards. System-level changes such as mandatory electronic prompts, improved documentation processes, and targeted education are urgently needed to enhance patient safety and prescribing practices.