If you’re breathless with excitement over Christmas, then do I have the ideal gift for you! A pulse oximeter!! It even fits in a cracker and comes with a joke!!! That being the Standard Operating Procedure for the Covid oximetry@home scheme, if you can be bothered to read it, which explains what we’re supposed to do with those giftwrapped oximeters CCGs have been stockpiling.
On the plus side, love that ‘at’ sign, NHS – so very down with the kids. Problem is, many oximeter users will misinterpret ‘oximetry@home’ as an email address, and wonder why no-one’s responding to their red-flagged: ‘My sats are dropping’ message. Stupidity? Maybe, but severe hypoxia can do that to you.
On the negative…well, I do acknowledge that it’s a fine line between micromanagement and lack of guidance. But this SOP manages to achieve both in the same document.
Because, to paraphrase, it states that, depending on their prescribed thrice daily self readings, patients should party on down (if >95%), dial 999 (if <93%) or contact 111/GP (if 92-93%). Hang on a minute: 92-93%? That’s a pretty narrow window, isn’t it? Doesn’t seem to allow much for margins of error in the kit, or for that bizarre fluctuation in readings you get as the pulse oximeter random number generator cranks into gear. Anyway, that’s the micromanagement.
We reach the opposite extreme with the guidance on what to do if you’re the GP receiving that call. Here the document is, ahem, vague, and seems just to mutter apologetically about ‘the option of more intense clinical assessment and oversight in the community’. I’m guessing here, but perhaps ‘More intense clinical assessment’ means to keep checking it until it improves, and ‘Oversight’ means forgetting to make a follow up call the next day.
Who knows? What I am sure of is that this kind of thing makes we want to scream and shout until I’m blue in the face. Which reminds me, just checked my sats and they’re 92.5%. So now what?
Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs at http://www.pulsetoday.co.uk/views/copperfield
READERS' COMMENTS [4]
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I think the figure of 92-93% is too high as well. Many otherwise fit smokers have oxygen levels of 95%. I had covid in January and my oxygen went down to 90% for two days and I’m not a smoker.
‘A pulse oximeter!! It even fits in a cracker and comes with a joke!!!’
Poetry?
Agree. I would quite regularly find a saturation of 92% in my patients and not bat an eyelid. Should I be 999ing them all?
I bought a pulse oximeter back in April. I also recommended that home pulse oximetry should be the order of the day (that was back in May). A low reading almost certainly doesn’t signify without symptoms, but if you have the usual collection (dry cough, fever, anosmia etc) AND your O2 sats are dropping to 90% or below then it’s time for hospital, in my view. It precedes other signs of decompensation seen in a developing cytokine storm, and if it doesn’t happen then the storm probably won’t. So many hospital admissions might be saved…