Clinical Audit of Acute Oxygen Therapy: Enhancing Patient Care at Dammar Teaching Hospital

Abstract

BACKGROUND: Oxygen therapy is a critical component of acute care, yet inappropriate administration remains a frequent concern, particularly in resource-limited contexts such as Sudan. Challenges with guideline adherence, infrastructure, and staff training necessitate clinical audits for quality improvement. OBJECTIVE: The objective of the study is to assess compliance with oxygen therapy guidelines at Dammar Teaching Hospital and evaluate the impact of targeted interventions on optimizing acute oxygen delivery. METHOD: The study is a prospective two-cycle clinical audit (Cycle 1: June-July 2024, n = 50; Cycle 2: December 2024, n = 40) against standards. Interventions included staff training and standardized checklists. Compliance was measured across nine parameters (device-specific flow rates, documentation, weaning, etc.). RESULTS: Compliance improved in several domains after the intervention. Correct device and flow use increased markedly for nasal cannula (50.0% to 92.3%) and non-rebreather masks (61.9% to 100.0%). Documentation also improved, with target SpO₂ recording in type 2 respiratory failure rising from 69.0% to 100.0% and routine SpO₂ monitoring from 50.0% to 82.1%. Immediate oxygen delivery for patients at risk of hypoxemia increased from 16.7% to 70.0%. However, compliance declined in oxygen weaning (76.2% to 45.0%) and timely discontinuation (78.6% to 47.5%). CONCLUSION: Educational interventions and clinical tools were associated with improved adherence to guidelines in oxygen delivery and documentation. However, declines in weaning/discontinuation highlight persistent de-escalation challenges. Sustained progress may require iterative audits, protocol reinforcement, and integration into electronic health records, which could provide a scalable model for similar settings.