Authors (including presenting author) :
Ng SW(1), Cheung PS (2), Tsui M (2), Cheng SL (2), Chan SE (2), Lee CL (2), Ng YB (2), Tsang WY (2), Tso E (2), Kung KN (2)
Affiliation :
(1) Nursing Service Division, United Christian Hospital, (2) Department of Medicine & Geriatrics, United Christian Hospital
Introduction :
High flow oxygen (HFO) therapy is a non-invasive respiratory support and proven to have clinical and physiological and, can prevent endotracheal intubation. During the 5th wave of COVID-19 with dramatically worsen situation in Hong Kong, there were many critically ill patients who developed acute hypoxaemic respiratory failure and required HFO therapy which was relatively new for extensive use in HA. A series of actions and measures had been taken to ensure safe and effective delivery of HFO therapy in United Christian Hospital.
Objectives :
To describe the approaches to ensure safe and effective delivery of HFO therapy and related care
Methodology :
In order to ensure safe and effective delivery of HFO therapy, six “C” approaches were implemented as follows:
Centralization of patients
For those COVID-19 patients who needed high flow oxygen therapy were monitored and admitted or transferred to four tier-one isolation wards and managed with local protocol.
Communication
A cluster based forum for HFO was conducted to share and discuss the use of HFO in KEC in March 2022
Competency enhancement
A series of training sessions for competency enhancement of caring patients with HFO had been implemented including open forum, lectures, workshops, use of competency checklist, train-the-trainer (TTT), onsite training and e-learning.
Caring guideline
Specialty Nursing Practice Guideline on High Flow Nasal Cannula was coordinated and developed by Nursing Service Division of HAHO in the end of 2022.
Care & Management support
Extra daily round had been provided by Respiratory team of the Department of Medicine & Geriatrics as care and management support for COVID-19 receiving HFO in designated tier-1 wards.
Concerns HFO therapy
Specific concerns for safe delivery of HFO therapy were discussed and identified for the surge including excessive demand of oxygen, capacity of oxygen system, transportation of patients with HFO and shortage of consumables of HFO therapy. Also, preventive measures had been made to ensure safe and effective delivery of HFO therapy as well as daily monitoring utilization of HFO.
Result & Outcome :
Result
This was fifty-one consecutive patients with mean age of 75.5 and 76.6% of male admitted for proven COVID-19 pneumonia with acute hypoxemia respiratory failure and requiring HFO therapy from 1/3/22 to 15/4/22. The average days of using HFO was 5.4 with up to thirteen patients receiving HFO a day. The average Initial settings were 60 L/min of air flow and 0.77 fractional of inspired oxygen while the average SpO% and respiratory rate was 90.8% and 20.75/min. respectively. A total of one cluster-based open forum, eight identical TTT workshops, a competency checklist, e-learning, three lectures, 9 sessions of on-site training had been completed from March to August in Kowloon East Cluster.
Conclusion
A mechanism was established in place to ensure safe and effective delivery of HFO therapy and related care.
