Oxygen PRN For Comfort? Why Do Nurses Do It?

Everyday I have to ask the question, Why do nurses place patients on PRN oxygen when they aren't hypoxemic?  I asked a nurse today, who was precepting a nursing student, why she did it.  The patient was 95% on room air, but was placed on nasal cannula oxygen because the oxygen made them feel better. Having oxygen on made them less short of breath.  Perhaps an oxygen expert, a nurse, or a patient could explain to me the physiology about how going from 95% to 97% oxygen saturation would make a patient feel better.  There is no physiological basis for introducing such a therapy.  It's one of those unnecessary interventions that drive up the cost of health care and increase the risk of complications.

As a hospitalist and a physician, my problem when nurses place unnecessary oxygen on patients is that it offers no therapeutic value and makes for a difficult discharge disposition.  With that said, having nurses give PRN oxygen for comfort would be the same as me ordering a sugar pill to cure sinus rhythm.  No insurance company, including Medicare, will pay for oxygen or oxygen supplies unless the patient has documented oxygen saturations of less than 88%.  I suspect the Medicare National Bank uses the the oxygen dissociation curve as the rationale for their payment cut offs for oxygen.   At least there is a rationale behind it. 

Placing a patient on a couple liters of oxygen causes me great difficulty in trying to decide if the patient is stable for discharge or if they are even stable in their hospital admission.   I can only assume that patients on oxygen are hypoxemic.  But when nurses start willy nilly placing patients on oxygen for comfort, I can't figure out if they really need oxygen and if an evaluation for hypoxemia needs to be done, or if I can just get rid of it and discharge the patient.

Oxygen prn for comfort should never be in the nursing arsenal for patient care.  As with any medication, oxygen therapy can come with its own complications and it's not cheap.   Using prn oxygen for comfort is about as bad as having telemetry cardiac monitoring when it's not necessary.  Just stop it.  Stop it right now.    Stop putting oxygen on patients who aren't hypoxemic.  There is no physiological reason to do.  Correct me if I'm wrong, but is placing unnecessary oxygen on patients a nursing education requirement handed down through generations of nursing students who repeat the cycle to infinity? 

Print Friendly and PDF