Emergency. 2017; 5 (1): e39 OR I G I N A L RE S E A RC H Familiarity of Physicians and Nurses with Different As- pects of Oxygen Therapy; a Brief Report Reza Goharani1, MirMohammad Miri1, Mehran Kouchek1, Mohammad Sistanizad2,3∗ 1. Department of Critical Care, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2. Department of Clinical Pharmacy, Faculty of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 3. Department of Pharmaceutical Care Unit, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Received: April 2016; Accepted: August 2016; Published online: 11 January 2017 Abstract: Introduction: Oxygen is a drug and physician and nurses should be familiar with the effects and potential risks of oxygen therapy. The current study aimed to assess familiarity of physicians and nurses with various aspects of oxygen therapy. Methods: In this cross sectional study, the familiarity of physicians and nurses with various aspects of oxygen therapy in a teaching hospital was evaluated using a validated questionnaire. The collected data were analyzed using SPSS 21 software. Results: 57 physicians and 79 nurses returned the completed ques- tionnaire (response rate 97.1%). Mean clinical work experience of participants was 6.9±5.7 (1–15) years. 98.2% of physicians believed that oxygen therapy can be associated with risk and should be recorded in the patient’s medical file. These measures were 92.4% and 98.2% for nurses. 38 (27.9%) participants correctly pointed out the reasons for oxygen therapy. Regarding necessary measurements and monitoring for oxygen therapy, 49 (86%) physicians and 65 (82.3%) nurses chose the correct answer. In addition, regarding necessity of blood gas anal- ysis during oxygen therapy, 44 (77.2%) physicians and 55 (69.6%) nurses chose the correct answer. Conclusion: The findings showed that the familiarity level of participants with some aspects of O2 therapy such as its indi- cations, necessary measurements and monitoring during therapy, and identifying delivery devices was fair to weak (<80%). Keywords: Oxygen; oxygen inhalation therapy; knowledge; adverse effects; physicians; nurses © Copyright (2017) Shahid Beheshti University of Medical Sciences Cite this article as: Goharani R, Miri M, Kouchek M, Sistanizad M. Familiarity of Physicians and Nurses with Different Aspects of Oxygen Therapy; a Brief Report. Emergency. 2017; 5 (1): e39. 1. Introduction Oxygen is one of the most common drugs used in secondary care in hospital. Oxygen is an essential component of re- suscitation, acute medical care, basic life support, anesthe- sia and postoperative care. When oxygen is used appropri- ately, it can save lives. On the other hand, any errors in oxy- gen therapy can worsen a patient’s condition and can even be life-threatening (1). Nowadays, the benefits and poten- tial complications of oxygen therapy are well known; how- ever, oxygen therapy is often done without special attention and sufficient knowledge (2-5). There are several guidelines ∗Corresponding Author: Mohammad Sistanizad; Department of Pharmaceu- tical Care Unit, Imam Hossein Hospital, Shahid Madani Avenue, Imam Hossein Square, Tehran, Iran. Tel: 0098-9122784895, Fax: 0098-2188200087 , Email: Sis- tanizadm@sbmu.ac.ir and protocols for appropriate oxygen therapy (2, 6). It has been shown that use of protocols for oxygen therapy in hos- pital wards can be very helpful in reducing errors during this process (7-9). Previous studies have evaluated the use of oxy- gen in hospitals (10, 11). These studies reveal that doctors often prescribe oxygen improperly and without adequate su- pervision. Modified charts for prescribing oxygen and related requirements have been proposed (2, 11). Dodd et al. have shown that introduction of a specific prescription chart for oxygen improves the quality of its prescription by junior doc- tors from 55% to 91%. However, these recommendations had a positive effect on patient care only if health professionals had proper information and sufficient understanding of oxy- gen therapy and its correct administration (12). To ensure the safe and effective oxygen delivery, flow rate, dose, devices, time, and method of monitoring should be given special at- tention and doctors and nurses should be familiar with the effects and potential risks of oxygen therapy. Based on the This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0). Downloaded from: www.jemerg.com R. Goharani et al. 2 above-mentioned, this study aimed to assess familiarity of physicians and nurses with various aspects of oxygen ther- apy. 2. Methods 2.1. Study design This cross sectional study was conducted in a teaching hos- pital affiliated to Shahid Beheshti University of Medical Sci- ences, Tehran, Iran, in 2014. The familiarity of physicians and nurses with various aspects of oxygen therapy was evaluated using a predesigned questionnaire. After a full explanation about the study design, written informed consent was ob- tained from all nurses and physicians. All information about the participants was kept confidential. The study protocol was approved by the ethics committee of Shahid Beheshti University of Medical Sciences. 2.2. Participants 60 physicians and 80 nurses working in different hospital wards were enrolled. All participants had some experiences in oxygen therapy. It was assumed that all participants had the basic skills and training about oxygen therapy. Question- naires were anonymous and 20 minutes were given to each participant to complete the questionnaire without confer- ring. 2.3. Questionnaire Internet search for international and local oxygen delivery guidelines was done and the most common and appropriate ones were used for designing a questionnaire (13, 14). Two consultant respiratory physicians, independently evaluated and confirmed the questionnaire items and responses. It was expected that questions about parameters in oxygen therapy would assess topics that all doctors and nurses had under- gone in education and training courses. In the first part of the questionnaire, participants were asked to identify oxygen delivery devices and choose their correct names. Then in the second part, a variety of questions about how to prescribe and deliver oxygen, and reasons for oxygen prescription were asked. The familiarity rate was categorized into five groups based on Likert scale: ≥ 90% as excellent, 80-90% good, 70- 80% fair, 60-70% weak and < 60% poor. 2.4. Statistical Analysis Data from the completed questionnaires were extracted and analyzed using SPSS version 17. To describe the data, fre- quency, percentage, mean, standard deviation, median, and interquartile range (IQR) were used. 3. Results: 3.1. Baseline characteristics 60 physicians and 80 nurses were studied. The response rate was 97.1%, and a total of 136 participants [57 physicians (54.4% female) and 79 nurses (70.9% female)] were involved. Average work experience of participants was 6.9 ± 5.7 years (1-15). 70 (51.5%) participants stated that there was a proto- col to prescribe oxygen in their ward. The usual method of oxygen delivery in hospital wards were nasal cannula (58.1%) and simple mask (33.1%), respectively. Table 1 shows the us- age percentage of different O2 delivery devices in the studied hospital. 3.2. Knowledge 98.2% of physicians believed that oxygen therapy can be associated with risk and should be recorded in the patient’s medical file. These measures were 92.4% and 98.2% for nurses. Table 2 shows the familiarity percentage of partic- ipants with different oxygen delivery devices. 38 (27.9%) participants correctly pointed out the reasons for oxygen therapy. Regarding necessary measurements and monitor- ing for oxygen therapy, 49 (86%) physicians and 65 (82.3%) nurses chose the correct answer. In addition, regarding necessity of blood gas analysis during oxygen therapy, 44 (77.2%) physicians and 55 (69.6%) nurses chose the correct answer. 4. Discussion: The findings showed that the familiarity level of participants with some aspects of O2 therapy such as its indications, nec- essary measurements and monitoring during therapy, and identifying delivery devices was fair to weak (<80%). Pre- vious studies had evaluated the use of oxygen at hospitals in other countries (10, 11). In a study conducted in 2006 by Ganeshan et al., knowledge of 53 nurses and 40 doctors that worked in intensive care unit of the General Hospital in UK and were active in oxygen prescription, was evalu- ated. 25% of the physicians and 50% of the nurses could not prescribe the right dose and method of oxygen therapy in cardiorespiratory arrest cases. They concluded that doc- tors and nurses did not have sufficient knowledge and under- standing of oxygen therapy (9). In a similar study, Brokalaki et al. assessed the knowledge of oxygen therapy in seven hospitals in a major city of Greece, in 2004. The question- naire was completed by 105 head-nurses. The results showed that training programs, protocols and guidelines should be mandatory to ensure proper use of oxygen therapy by nurs- ing personnel (14). In our study, approximately half of par- ticipants said that there is no protocol to prescribe oxygen This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0). Downloaded from: www.jemerg.com 3 Emergency. 2017; 5 (1): e39 Table 1: The most often used oxygen delivery devices in Imam Hossein hospital Devices Number (%) Nasal cannula 79 (58.1) Simple face mask 45 (33.1) Non-Rebreathing face mask with reservoir bag 6 (4.4) Venturi mask 6 (4.4) Table 2: Familiarity of participants with different oxygen delivery devices Devices Nurses Doctors Nasal specs/prongs/cannula 79 (100) 54 (94.7) Bag mask ventilation 78 (98.7) 57 (100) Venturi mask 76 (96.2) 50 (87.7) Rebreathing face mask 41 (51.9) 40 (70.2) Non-rebreathing face mask with reservoir bag 41 (51.9) 45 (78.9) Data were presented as number and percentage. in their wards, despite the existence of several international guidelines for proper oxygen therapy (2, 6). However, only 51.9 to 78.9% of the nurses and doctors recognized O2 de- livery devices such as non-rebreathing mask with reservoir bag, which is consistent with Ganeshan et al. results (13). In the present study, only 38 participants (27.9%) correctly pointed out the indications for oxygen therapy, namely de- creased level of consciousness, chest pain, respiratory dis- tress, seizure, severe respiratory infections and sepsis. 98.2% of physicians and 92.4% of nurses believed that oxygen ther- apy can be associated with risk. Any error in oxygen ther- apy could lead to worsening of the patient’s status and can even be life-threatening (1). Although oxygen is used for the treatment of hypoxia, it can be deadly and should be consid- ered as a drug (2). In our study, 33 (57.98%) physicians and 47 (95.5%) nurses believed that oxygen is a drug. In another study, it was shown that 59% of a hospital’s head nurses be- lieve that oxygen is a drug and should be administered with prescription, while 41% believe that the oxygen is a gas that improves patients’ breathing (14). This study reveals that the knowledge of doctors and nurses on how to correctly use oxy- gen is fair to weak (in some aspects) and this could have a harmful effect on their performance. It is clear that more emphasis on training in oxygen therapy is necessary during basic training courses for doctors and nurses; and constant and dynamic monitoring on personnel’s learning and per- formance should be applied. Therefore, more consideration and further theoretical and practical training courses in this field seems to be necessary. Small sample size and failure to evaluate the attitude and practice of participants are among the limitations of the present study and it is recommended to conduct more studies in this regard. 5. Conclusion: The findings showed that the familiarity level of participants with some aspects of O2 therapy such as its indications, nec- essary measurements and monitoring during therapy, and identifying delivery devices was fair to weak (<80%). There- fore, more consideration and further theoretical and practi- cal training courses in this field seems to be necessary. 6. Appendix 6.1. Acknowledgements Many thanks to colleagues for their assistance and consul- tation in designing the questionnaire. Warm thanks to re- spected doctors and nurses who helped in carrying out our plan and completed the questionnaires with patience; with- out their assistance this project was not possible. 6.2. Authors contribution All authors passed four criteria for authorship contribution based on recommendations of the International Committee of Medical Journal Editors. 6.3. Conflict of interest None. 6.4. Funding Special thanks to Clinical Research Development Unit of Imam Hossein Hospital, affiliated to Shahid Beheshti Uni- versity of Medical Sciences, for the registration and financial support. This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0). Downloaded from: www.jemerg.com R. Goharani et al. 4 References 1. Fitzgerald JM, Baynham R, Powles AC. Use of oxygen therapy for adult patients outside the critical care areas of a university hospital. Lancet. 1988;1(8592):981-3. 2. Bateman NT, Leach RM. ABC of oxygen. Acute oxygen therapy. BMJ. 1998;317(7161):798-801. 3. Kallstrom TJ. AARC Clinical Practice Guideline: oxygen therapy for adults in the acute care facility–2002 revision & update. Respir Care. 2002;47(6):717-20. 4. Al-Mobeireek AF, Abba AA. An audit of oxygen therapy on the medical ward in 2 different hospitals in Central Saudi Arabia. Saudi Med J. 2002;23(6):716-20. 5. 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