Home oxygen ordering

Home Oxygen and Review Service (HOS-AR) BNSSG

Home Oxygen and Review Service (HOS-AR) is a service which supports the assessment and prescribing of long-term oxygen therapy and ambulatory oxygen for people who have chronic hypoxia due to a long term condition such as COPD. It is also used as a treatment methodology for some neurological conditions e.g. cluster headaches and epilepsy. Services are run across BNSSG by secondary and community care providers.

Complete the Oxygen Referral Form and email it to sirona.respiratory@nhs.net 

Patients can request the provider of their care otherwise it will be triaged by a HOSAR clinician, when the BNSSG provider will be allocated based upon their location and clinical requirements.

Please contact the Community Respiratory team for any advice and guidance.

Ordering of Home Oxygen

Who are you prescribing for?

1. Patients with chronic hypoxaemia (resting saturations <92%) who meet the guidance for Long Term Oxygen Therapy (BTS 2015) Consider referral to the Home Oxygen Assessment & Review service (HOSAR, see details below) following a period of clinical stability of 8 weeks, ensuring patient is medically optimised (on maximal inhaled therapy, co-morbidity optimisation, post-pulmonary rehabilitation and following appropriate stop smoking treatment) 

2. Patients who desaturate on exertion who you feel may benefit from oxygen- Any patient who you think requires ambulatory oxygen must be assessed by HOSAR Service. This will include a walk test to assess for desaturation and response to oxygen. A period of an 8 week stability plus medical optimisation is also required. 

3. Patients who are experiencing severe breathlessness secondary to hypoxaemia due to their palliative condition occasionally and may benefit from oxygen  - see when to consider oxygen - NICE health topics section on dyspnoea in Palliative care specifically provides guidance of  when to consider oxygen therapy Scenario: Symptomatic treatment | Management | Palliative care - dyspnoea | CKS | NICE

For local advice on management of EOL symptoms see the End of life care page of Remedy

Because of fire risks, home oxygen should not usually be prescribed to people who smoke. There are specific conditions which need to be met before prescribing home oxygen to people who smoke. The full policy can be viewed in the Formulary guidelines: Home oxygen prescribing guidelines NHS SW region- Prescribing of oxygen to patients who are known to smoke

In BNSSG, patients should usually be referred to the HOSAR service for oxygen initiation, however in urgent circumstances it is possible for another prescriber to order oxygen via a Home Oxygen Order Form (HOOF) Part A.

There are two versions of a HOOF

• HOOF-A is for GPs, Hospital Doctors, Nurses when necessary to order home oxygen in an EMERGENCY before specialist assessment. A HOOF-A will only allow the temporary ordering of static oxygen i.e. an oxygen concentrator, and not portable cylinders.
• HOOF-B is ONLY to be completed by the Home Oxygen Assessment Service (HOS-AR service) after formal assessment of a patient.

Part A prescription (HOOF-A)

The home oxygen provider in the South-West of England is Air Liquide and orders are placed via their online portal.

Registration. Clinicians who want to submit a HOOF Part A will need to register. The process is straightforward and should only take a few minutes. Details you enter when registering will be captured in your profile and be used to automatically populate fields throughout the ordering process, saving you time.

IHORM and HOCF integration. Air Liquide have integrated the initial home oxygen risk mitigation (IHORM) and home oxygen consent form (HOCF) into the portal to provide clinicians a central point where it can be completed and stored. (Completed forms can be viewed and/or updated by other clinicians who access the HOOF Part B portal). Any information that is entered on the IHORM will NOT be acted upon by Air Liquide Healthcare Limited.

Completion of these forms has been mandatory for many years so the integration will help to streamline the entire ordering process. This includes a reminder for the clinician to refer patients to the local HOS-AR (Home Oxygen Service - Assessment and Review).

If you need further guidance, a copy of the HOOF Part A - Portal User Guide is available to download https://www.airliquidehomehealth.co.uk/hcp/

If you encounter any problems, please contact Air Liquide customer services team on 0808 202 2099 or via email: alhomecare.hcpsupport@nhs.net

Home Oxygen Service | Air Liquide Homecare UK - Home Oxygen Portal (airliquidehomehealth.co.uk)

HOOF Part A Portal User Guide 

Advice for prescribing oxygen during COVID-19

For patients not for escalation to hospital, as per treatment escalation plan but for palliation the End of Life guidelines should be considered.

High flow oxygen for Cluster Headaches

Short burst high flow oxygen should generally only be considered if a firm diagnosis of cluster headache has been made and other first line treatments and lifestyle measures have been tried initially, or on the advice of a neurologist (consider using Neurology advice and guidance). 

See the Headache page for advice on diagnosis and management of cluster headaches.

Referrals can be made to the community team, or oxygen can be ordered via the HOOF on line portal.

If there are no contra-indications, CKS recommends 100% oxygen at a flow rate of 12–15 litres per minute via a non-rebreather face mask for 15 to 20 minutes.

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.