Table 1.

Key themes identified through FRAM analysis, aspect of functions which these relate to, and traditional and new interventions which were identified through FRAM analysis and considering these aspects

Findings/quotationRelated FRAM aspect(s)Traditional interventionsNew interventions identified through FRAM analysis
Prescribing was done for convenience rather than need
‘We prescribe all the oxygen categories available on the EPS [electronic prescribing system] so that whatever the patient needs, it's covered. Patient need is so variable that it doesn't make sense to be too precise.’ (Junior doctor)
ControlElectronic observation charts with reminders based on observed dataaAutomatic prompt within EPS on prescription type based on history and observations, to encourage healthcare professionals to think about what oxygen to prescribe and why, rather than prescribing all the different typesb
Involvement of pharmacy team as part of drug reviews to add an extra layer of control and reviewb
Knowledge of harms of oxygen was variableOutcomeEducation of medical and nursing staff, via formal e-learning and face-to-face methods, as well as informal reminders on wardaScreensavers about safe oxygen use to remind healthcare professionals what outcomes we are trying to achieve and what we are trying to avoida
Oxygen was readily available, so prescribing did not influence receipt
‘Nurses give oxygen before the patient's been seen by a doctor – it's not practical to wait for a doctor. And doctors would think they [nurses] were mad for bleeping them to come and prescribe oxygen !’ (Nurse)
Resources; timeReminders next to oxygen ports on wallb
Highlighting to staff within the Trust cost savings programmeb
Cost of oxygen was not something staff thought much about
Responsibility for oxygen seemed to fall between nurses and doctors, with each perceiving some level of responsibility for the other staff group
‘The most important thing is that the nurses and doctors discuss the patient's oxygen needs – putting the prescription on the EPS doesn't really help or mean anything.’ (Nurse)
PreconditionEducation, as aboveaImplementation of ward round checklist to have a regular review of what oxygen is/is not prescribed and the target saturationsb
Implementing Trust QI leadership standards to promote an MDT approach, encourage conversations between groups and promote all members to effect positive change of organisational cultures and microcultures, to facilitate improvement in safe oxygen administrationb
Giving oxygen is more important than prescribing it
See quote given under ‘Precondition’
InputEducation, as abovea
Posters pertaining to oxygen prescription to remind staffa
Prescribing practices focused on saving staff time
‘I just prescribe oxygen for every patient I clerk, even if they don't seem like they're going to need it. Then it's on there if they do need it.’ (Junior doctor)
TimeEducation as aboveaGuidance within EPS on prescription typeb
Staffing level reviewb
  • Aspects are related to individual FRAM functions, as seen within the network diagram where the full breakdown and network can be seen (Fig 1). However, to simplify reporting, we have extrapolated findings up to consider the singular system function within this table.

  • aIntervention implemented during project.

  • bFuture and potential interventions.