Adams J. Ethical issues in independent and supplementary prescribing, 2nd edn. In: Courtenay M, Griffiths M (eds). New York: Cambridge University Press; 2010

Amani H, Lozano DD, Blome-Eberwein S. Brother, have you got a light? Assessing the need for intubation in patients sustaining burn injury secondary to home oxygen therapy. J Burn Care Res.. 2012; 33:(6)e280-285

Beauchamp TL, Childress JF. Principles of biomedical ethics, 7th edn. Oxford: Oxford University Press; 2013

Bickley L. Bates' guide to physical examination and history taking, 11th edn. London: Lippincott Williams and Wilkins; 2014

Broadhead R. Professional, legal and ethical issues in prescribing practice, 2nd edn. In: Nuttall D, Rutt-Howard J (eds). Chichester: John Wiley and Sons; 2016

Information on the new home oxygen service.London: British Thoracic Society; 2006

Carey N, Stenner K. Does non-medical prescribing make a difference to patients?. Nurs Times. 2011; 107:(26)14-16

Chang TT, Lipinski CA, Sherman HF. A hazard of home oxygen therapy. J Burn Care Rehabil.. 2001; 22:(1)71-74

Cooper BG. Home oxygen and domestic fires. Breathe (Sheff). 2015; 11:(1)4-12

Cooper R. The ethics of prescribing. In: Lymn J, Bowskill D, Bath-Hextall F, Knaggs R (eds). Chichester: John Wiley and Sons; 2010

Courtenay M, Carey N, Stenner K, Lawton S, Peters J. Patients' views of nurse prescribing: effects on care, concordance and medicine taking. Br J Dermatol.. 2011; 164:(2)396-401

Department of Health. Supplementary prescribing by nurses, pharmacists, chiropodists/podiatrists, physiotherapists and radiographers within the NHS in England (archived). 2005. (accessed 12 July 2019)

Department of Health. Medicines matters (archived). 2006. (accessed 12 July 2019)

Department of Health. Making the connections: using healthcare professionals to deliver organisational improvements (archived). 2008. (accessed 12 July 2019)

Department of Health. High quality care for all: our journey so far (archived). 2009. (accessed 12 July 2019)

Department of Health, Social Services and Public Safety. Quality 2020.A 10-year strategy to protect and improve quality in health and social care in Northern Ireland. 2012. (accessed 12 July 2019)

Department of Health, Social Services and Public Safety. Service framework for respiratory health and wellbeing. 2015. (accessed 12 July 2019)

Department of Health (Northern Ireland). Prescribing by non-medical healthcare professionals. 2019. (accessed 15 July 2019)

Dimond B. Legal aspects of nursing, 6th edn. Harlow: Pearson Higher Education; 2011

The expanding role of nurse prescribers. 2016. (accessed 12 July 2019)

Edwards SD. Nursing ethics: a principle-based approach, 2nd edn. London: Palgrave; 2009

Global Initiative for Chronic Obstructive Lung Disease. Pocket guide to COPD diagnosis, management and prevention. A guide for health care professionals. 2017. (accessed 12 July 2019)

Griffith R, Tengnah C. Law and professional issues in nursing, 3rd edn. London: Sage Publications; 2014

Hardinge M, Annandale J, Bourne S British Thoracic Society guidelines for home oxygen use in adults: accredited by NICE. Thorax. 2015; 70:i1-i43

Hassan Z, Wong JK, Bush J, Bayat A, Dunn KW. Assessing the severity of inhalation injuries in adults. Burns. 2010; 36:(2)212-216

Herring J. Medical law and ethics.Oxford: Oxford University Press; 2008

Hinkle JL, Cheever KH. Brunner and Suddarth's textbook of medical-surgical nursing, 13th edn. London: Lippincott Williams and Wilkins; 2014

Kent BD, Mitchell PD, McNicholas WT. Hypoxemia in patients with COPD: cause, effects, and disease progression. Int J Chron Obstruct Pulmon Dis.. 2011; 6:199-208

Lacasse Y, LaForge J, Maltais F. Got a match? Home oxygen therapy in current smokers. Thorax. 2006; 61:(5)374-375

Lacasse Y, Lecours R, Pelletier C, Bégin R, Maltais F. Randomised trial of ambulatory oxygen in oxygen-dependent COPD. Eur Respir J.. 2005; 25:(6)1032-1038

Lindford AJ, Tehrani H, Sassoon EM, O'Neill TJ. Home oxygen therapy and cigarette smoking: a dangerous practice. Ann Burns Fire Disasters. 2006; 19:(2)99-100

Lovatt P. Legal and ethical implications of non-medical prescribing. Nurse Prescribing. 2010; 8:(7)340-343

Report of the Medical Research Council Working Party. Long term domiciliary oxygen therapy in chronic hypoxic cor pulmonale complicating chronic bronchitis and emphysema. Lancet. 1981; 1:(8222)681-686

Murabit A, Tredget EE. Review of burn injuries secondary to home oxygen. J Burn Care Res.. 2012; 33:(2)212-217

National Institute for Health and Care Excellence. Chronic obstructive pulmonary disease in over 16s: diagnosis and management. NICE guideline. 2018. (accessed 12 July 2019)

Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease: a clinical trial. Ann Intern Med.. 1980; 93:(3)391-398

Nursing and Midwifery Council. The Code: professional standards of practice and behaviour for nurses, midwives and nursing associates. 2018a. (accessed 10 July 2019)

Nursing and Midwifery Council. Future nurse: standards of proficiency for resitered nurses. 2018b. (accessed 11 July 2019)

Nuttall D. Prescribing in context, 2nd edn. In: Nuttall D, Rutt-Howard J (eds). Chichester: John Wiley and Sons; 2016

Porth CM. Essentials of pathophysiology, 4th edn. Philadelphia (PA): Wolters Kluwer Health; 2015

Robb BW, Hungness ES, Hershko DD, Warden GD, Kagan RJ. Home oxygen therapy: adjunct or risk factor?. J Burn Care Rehabil.. 2003; 24:(6)403-406

Royal Pharmaceutical Society. A competency framework for all prescribers. 2016. (accessed 10 July 2019)

Rutt-Howard J. Effective consultations and the consultation umbrella, 2nd edn. In: Nuttall D, Rutt-Howard J (eds). Chichester: John Wiley and Sons; 2016

Shiner RJ, Zaretsky U, Mirali M, Benzaray S, Elad D. Evaluation of domiciliary long-term oxygen therapy with oxygen concentrators. Isr J Med Sci.. 1997; 33:(1)23-29

Silverston P. Effective safety-netting in prescribing practice. Nurse Prescribing. 2014; 12:(7)349-352

Suntharalingam J, Hippolyte S, Knowles V, Freeman D, Patel I, Hardinge M. When should I be considering home oxygen for my patients?. NPJ Prim Care Respir Med.. 2016; 26

An evaluation of the expansion of nurse prescribing in Scotland (final report). 2009. (accessed 12 July 2019)

Young A. Professionalism and ethical issues in nurse prescribing. Nurse Prescribing. 2010; 8:(6)284-290

Home oxygen therapy in patients with COPD: safety issues for nurse prescribers

25 July 2019
Volume 28 · Issue 14


Two landmark studies demonstrated survival benefit in chronic obstructive pulmonary disease (COPD) complicated by chronic hypoxaemia with the prescription of long-term oxygen therapy (LTOT). Best practice evidence therefore recommends that individuals with stable COPD and resting hypoxaemia (PaO2≤7.3 kPa) should be assessed for long-term oxygen therapy. However, it is estimated that up to one-quarter of COPD patients prescribed LTOT continue to smoke. Oxygen therapy consequently presents an obvious fire hazard in the case of such patients, who are therefore at greater risk of death or sustaining devastating head and neck burns. This article critically analyses, through the context of a care study, the professional, ethical and legal issues involved in making a safe prescribing decision for LTOT in an individual with COPD who is a current smoker. Home oxygen prescription is a growing trend in the COPD population, and it is important for nurse prescribers to be aware of the issues highlighted in the article to ensure safe prescribing practices.

The author is a respiratory nurse specialist (RNS) practising as part of a community nurse-led respiratory assessment service. The RNS is responsible for ensuring that individuals with respiratory disease receive holistic care and is are empowered to develop expertise and advanced professional practice. The Department of Health (DH) (2008) advocated that such proficiency should be achieved through the appropriation of non-medical prescribing, which is now recognised as one of the most important developments in nursing since it became a profession in the early 20th century (Dowden, 2016).

The benefits of nurse prescribing are well documented, with qualitative evidence demonstrating positive outcomes in efficiency of care (Courtenay et al, 2011), increased nurse autonomy (Watterson et al, 2009) and greater patient satisfaction (Carey and Stenner, 2011). Therefore, with current governmental demands to ensure high-quality care provision regionally (Department of Health, Social Services and Public Safety (DHSSPS), 2012) and nationally (DH, 2009), independent and supplementary non-medical prescribing has been recognised as a valuable asset for advanced nursing practice.

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content