The Blue Cross Medical Necessity Guidelines require evaluation of oxygen therapy. We have developed a protocol for evaluation of oxygen therapy by respiratory therapists. This protocol not only evaluates oxygen therapy at the flow and FIO 2 at which it is prescribed but assists the physician in determination of whether more or less oxygen is needed. If carbon dioxide retention is suspected, arterial blood gas analysis is used in the assessment; when carbon dioxide retention is not suspected, pulse oximetry is used. When oximetry is used, the respiratory therapist determines the SaO 2 on the prescribed oxygen flow or FIO 2 . If the SaO 2 is < 95%, the therapist determines the oxygen flow or FIO 2 required to achieve an SaO 2 of 95%. If the SaO 2 is ⩾ 95%, the SaO 2 with the patient breathing room air is determined. If the room air SaO 2 drops to < 88%, the oxygen flow or FIO 2 required to achieve an SaO 2 of 95% is determined. At the end of the assessment, the oxygen flow or FIO 2 is returned to the prescribed settings, and the results are reported to the physician. This oxygen-therapy-assessment protocol has been well accepted by the physician staff, who have found these assessments helpful in the determination of appropriate oxygen prescriptions, and by the respiratory therapy staff, who have been able to exercise patient-evaluation and decision-making skills and to know that they have contributed to improved patient care.
Smoker et al. (Wed,) studied this question.