Page 81 - COVID-19 Inpatient Training Resources

Document Name: COVID-19 Guidelines for Initiation and Titration of O2 in the COVID-19 Adult Patient
Developed Date: 2020 04 21
Expiry Date: 2021 04 21
Distribution Approved by: Incident Management Committee
Contact for suggestions for next version: CPL, Charge RT, Dr. David Casey (GIM physician)
Intended use: SJHC site; for reference at SMH and Providence

Guidelines for initiation and titration of Oxygen in the COVID-19 adult

patient

Associated Governing Documents
This protocol is a supporting document to guide the unique aspects of patient care for adult inpatients
with COVID-19.

For governing documents related to the initiation and titration of Oxygen for adult patients, please refer
to:
Medical Directive: Initiation, Titration and Discontinuation of Oxygen Therapy for Adult Patients
Oxygen Standard of Care for the Adult Patient
Standard of Care: Prone Position Therapy in the ICU

General Principles
 Adult patients with COVID-19 are at risk for rapid deterioration marked by a decline in SPO2 and an
increase in oxygen dependency over a relatively short period of time
 In caring for COVID-19 patients, it is imperative that clinical teams monitor patient status closely and
respond in a very timely manner to a patient who is demonstrating signs of clinical deterioration

This document represents our current best level of knowledge but will be modified on an ongoing basis
as new information becomes available. This document has been reviewed by representatives from
General Internal Medicine, Respiratory Therapy, Inter-professional Practice (nursing, health disciplines).

Guidelines for Care

 The patient will be placed on the minimum amount of O2 required to keep SpO2 90-96% OR the
minimum amount of SpO2 prescribed by the Most Responsible Physician (MRP) or Nurse Practitioner
(NP).
 Vital signs to be monitored according to the following schedule. In Sunrise these will be added to the
Communication Orders.
o SpO2 assessment q2hours.
o Full set of vital signs to be performed q4hours (Blood Pressure, Heart Rate, SpO2, Respiration
Rate, Temperature and Pain)
 Call MRP if oxygen requirements increase by 3 liters from patient baseline
 Monitor patient for changes in respiratory status and contact REACT or MRP when oxygen
requirements exceed Fi02 0.40 or 6 liters of oxygen or when patient demonstrating signs of clinical
deterioration
 When clinically indicated remote continuous pulse oximetry can be considered for COVID+ and
Persons Under Investigation and requires a physician order for initiation. Remote continuous
oximetry is not available in all clinical areas.

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Version 3.1 August 17, 2020