Ordering home oxygen for children- a quick guide
Documents:
This page tells you all you need to know about prescribing oxygen. At the bottom of the page are links to pdf documents you will need to complete, including the home oxygen order forms. These forms can be downloaded and stored on your on computer to be printed off when needed. Alternatively you can print them directly from this site.
Here is a CHECKLIST to help the bemused clinician filling in and copying forms. It may be helpful to complete this as you copy all the forms, and file it with the retained copies.
CHORD, the Children’s Home Oxygen Record Database
There is a dearth of information about oxygen usage and practices around the country. The new oxygen prescribing system has given us the opportunity to collate this information, and to look at variation in practice with a view to designing prospective studies.
There is now a clinical network structure for paediatric home oxygen prescribing, and we have MREC approval for the collection of data on all children whose parents give consent (the MREC approval letter in pdf format is available here). In the first instance this will just be basic data about older children, but we will be gathering more detail on babies with chronic lung disease of prematurity.
How you can help: All the prescribing clinician has to do is to get informed consent, and complete the first half of the paediatric home oxygen record form. This form is then sent to CHORD (address on form). The original of the form should be filed in the notes, and should be useful as a clinical review record. (You may find that some children do not require such detailed observation or monitoring as is detailed in the form- just leave these spaces blank.
We will contact you for relevant babies/children (at present this is just chronic lung disease of prematurity) after 1 year to ask for a photocopy of the updated record form. If the child is still oxygen-dependent we will repeat this in subsequent years.
Please contact Ian Balfour Lynn, Consultant in Paediatrc Chest Medicine at Royal Brompton Hospital, (i.balfourlynn@imperial.ac.uk) if you want further information.
THANK YOU FOR HELPING
Ordering home oxygen
- Print out a copy of each document (see below).
- Ask the parents to sign the Home Oxygen Consent Form which is obligatory before the
oxygen company can be contacted with the patient details. This is kept in patient’s notes.
- Complete the 1 page Home Oxygen Order Form (HOOF) and fax it to your regional oxygen provider.
It is advisable to telephone them first so they can expect the order form. The telephone and
fax numbers for each provider are on the 1 page guidance sheet, which accompanies the form.
- Make 4 photocopies of the HOOF. Send a copy to your local PCT/LHB; to the patient’s GP;
the Paediatric Clinical Lead for Home Oxygen for your Trust (the regional lead can give you
the name of your local Trust lead); and finally send one to the national database (CHORD) if
the parents consent (see below). File the original HOOF in the patient’s records.
Paediatric Home Oxygen Record Form
- Complete the first section of the Paediatric Home Oxygen Record Form and file it in the
child’s notes. When the child is reviewed please update the oxygen assessment section at
appropriate times.
- If the child is using oxygen intermittently for palliation then please specify this in the
“Additional information” section. This may make some other sections of the form
irrelevant, but it would be helpful if some assessment of oxygen use is made.
- If there are any queries regarding CHORD please contact Dr Ian Balfour-Lynn on
i.balfourlynn@ic.ac.uk.
Children’s Home Oxygen Record Database – CHORD
- Explain about the national database, and in the case of parents of babies with chronic
neonatal lung disease, the follow up study. Ask them to sign the consent form if they are
willing to take part. Obviously this is not obligatory but it is important to ensure maximal
ascertainment for the database to be valid.
- If the parents have consented to a record being held in the database, the consent form is
copied twice – one copy for the parents, one for the database and the original goes in the
patient notes.
- Then send a copy of the HOOF and consent form to:
CHORD
c/o Dr Ian Balfour Lynn
Consultant in Paediatric Respiratory Medicine
Royal Brompton Hospital
Sydney Street
London SW3 6NP
- If they have not agreed to the database, please send a CHORD refusal form to the above
address.
Information sheets
Documents to be completed
Additional helpful information
Notes on Home Oxygen Parent Held record sheet
There are sometimes problems with engineers working for the oxygen suppliers coping with the rapidly changing needs of our patients. This parent-held record is a suggested way of preventing any potential confusion. The sheet should be given to the parent(s), perhaps in a clear A4 document wallet, and every change in oxygen flow can be clearly documented. If instructions are given by phone, then the parents can complete the telephone instructions, and the health care professional can sign it off at the next visit. The form should be kept attached to the concentrator. Our sheets are printed on hospital headed notepaper, but feel free to adapt as needed.
Rob Primhak 1 Sept 2006
Request to remove home oxygen equipment
This document is a standardised letter to request the oxygen supplier to remove equipment from one or more addresses. This may be because the patient no longer needs oxygen, or that they are no longer at the school, or visiting the relative specified in the secondary address. You could use this proforma to ask for removal from one primary and one secondary address. In the case of a child who has more than two sites for home ooxygen, you will need to complete a further form for each further secondary address. This is not an official form, just a useful proforma for you to adapt for your own use. It is suggested that you print it on your own hospital notepaper. It would probably be sensible to send a copy of the completed form to the GP and to the PCT/LHB.
Rob Primhak 1 Sept 2006
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