11:42AM, Monday 01 February 2021
Paramedics at South Central Ambulance Service (SCAS) have become the first in the country to supply COVID-19 patients with 'home oxygen monitoring kits'.
The kits - which contain a pulse oximeter device, a symptom diary and a set of strict guidelines - are given to people if they don’t require immediate admission to hospital but are at higher risk of complications from the virus.
The initiative will ensure patients who have mild symptoms but have other risk factors, such as being aged over 65, can monitor their oxygen levels and know when to seek help.
Clinicians at SCAS identified that just a slight drop in blood oxygen levels - but still within the 'normal range' - could be an early warning sign of deterioration in patients before the onset of breathlessness.
In most cases of bacteria and non-COVID pneumonia, shortness of breath appears relatively early in the disease and ahead of any significant drop in oxygen levels, known as hypoxia.
However, with COVID-19, a drop in oxygen levels often comes first, which is referred to as 'silent hypoxia', and patients can be significantly unwell by the time they become breathless.
The team, which included SCAS medical director Dr John Black and divisional medical director professor Charles Deakin, studied almost 20,000 patients who called for an ambulance between March 1 and July 31 last year.
They analysed the oxygen levels of 1,080 confirmed COVID-positive patients at the point they were initially assessed by paramedics at home.
Patients whose blood oxygen levels dropped only 1 per cent, to 2 per cent below 96 per cent - still within the normal range of 94-98 per cent - and showed no signs of shortness of breath often went on to require admission to intensive care and had a lower chance of survival.
Following the study, NHS England launched a nationwide rollout of its 'COVID Oximetry @home' initiative, which involves supplying home pulse oximetry kits to people who test positive and are at higher risk of complications.
SCAS says that about 300,000 have been supplied to patients across the country so far by local health systems.
The oximeters work by placing a clip on the end of a finger to measure oxygen in the blood and heart rate and, if oxygen levels drop to 94 or 93 per cent, patients are asked to call their GP or NHS 111 – or 999 if it falls to 92 per cent or less.
Dr Black said: “Our original research helped to inform the wider rollout of the COVID Oximetry @home project to enable patients in high-risk groups to monitor their blood oxygen levels directly and help ensure timely referral to hospital when indicated.
“We are now pleased to be the first ambulance service to offer pulse oximeters to patients along with guidance once we have assessed them and determined they don’t need to be taken to hospital but are at increased risk of their condition changing.
“It provides patients with the reassurance that they can keep a regular check on their oxygen levels independently and seek the help they need if their levels drop below 95 per cent, while for us it means our clinicians can leave patients knowing they have the ability to spot any change promptly and take swift action.”
Dr Matthew Inada-Kim, a consultant in general and acute medicine at Hampshire Hospitals NHS Foundation Trust, added: “SCAS has produced ground-breaking research that has informed national policy and led to the evolution of the COVID home oximetry model and its staff are again leading the way with this new project to help identify patients at risk as early as possible.”
An additional tab is being added to paramedics’ electronic patient record devices to allow them to record the provision of a pulse oximeter to help with a retrospective review of the effectiveness of the initiative.
Dr Black said: "It is hoped that prompt identification of hypoxia through home oximetry will lead to earlier admission to hospital for patients who subsequently deteriorate.
"This has the potential to improve the clinical outcomes of COVID-19 patients who develop complications."
If a patient does not suffer any further complications and makes a recovery at home, they are asked to return the device after 14 days to their own GP surgery or local 'COVID Oximetry @home' service.
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