Hospitals told to involve engineers in ‘clinical decisions’ about oxygen

In an internal briefing note seen by HSJ, NHS England and Improvement told trusts to ensure “regular consultation and involvement of the MGPS [Medical Gas Pipeline Systems — an engineering training and consultancy firm] authorised engineer in the clinical decision-making process”.

The briefing was issued on new year’s eve in response to the increasing number of covid-19 patients in hospitals, particularly those requiring help with breathing. According to NHSE data, as of 13 January, hospitals across England have 32,689 covid-19 patients, of which 3,307 — 10 per cent — are in mechanical ventilation beds. 

NHSE/I told HSJ it was important trusts involve engineers in decisions so medical staff stay informed of new guidance around medical equipment, for example when moving patients to areas that require oxygen supplies. However, it stressed engineers are not “responsible” for clinical decisions about patients.

A number of trusts have recently struggled with oxygen supply issues. The BBC reported doctors at Southend Hospital were told to lower patients’ oxygen intake because of a “critical situation with oxygen supply”. 

Meanwhile, The Independent reported Epsom and St Helier University Hospitals Trust had to transfer patients to neighbouring trusts after oxygen demand led to unsustainable pressure on its pipes. 

NHSE/I’s instructions come four months after it warned engineers had repeatedly highlighted the need for hospitals to take remedial action over their oxygen supply infrastructure (see attachment below this story).

At that time, the regulator criticised trusts’ inaction on the issue “despite warnings of potentially serious consequences for patient safety”.

The briefing stated: “All too often, the same remedial action appears year on year in the [engineers’] Audit Report… These timescales are not to be ignored or taken lightly.”

In addition to ordering more involvement of clinical engineers, NHSE/I told trusts to maintain an effective “vaporiser de-icing regime”.

This is necessary to prevent a build-up of ice on pipework connected to the oxygen tank, which often happens when oxygen use increases.

NHSE/I also reminded trusts to switch off oxygen supplies connected to areas of hospitals not in use, and to ensure that bed modelling and planning takes “full account” of oxygen capacity and flow availability.

Several trusts also experienced intense pressure on their oxygen infrastructure during the first wave of the pandemic, but NHSE/I said in August that no trust ran out of oxygen in that period.