A pulse oximeter is a small medical device that is put on the tip of the finger. By regularly monitoring oxygen levels it can be easier to spot if coronavirus symptoms are getting worse and whether people need treatment or support.
The Oximetry@Home service is an enhanced package of care that is provided over a 14 day period (from the date of symptoms commencing) in the patient’s own home, for individuals with confirmed Covid-19. The purpose is to aid the detection of silent hypoxia early and thus ensure the patient receives the necessary treatment to reduce the risk of mortality and morbidity in known or suspected Covid-19 positive patients.
This service is available to all 19 North Lincolnshire General Practices and is provided by Safecare Network Limited.
What is a pulse oximeter?
A pulse oximeter is a small medical device that is put on the tip of the finger, to check someone’s oxygen levels. Pulse oximeters measure blood oxygen levels by transmitting light through a finger – they are more accurate than smart watches or phones which make less accurate reading by reflecting light off the skin. By regularly monitoring oxygen levels, it can be easier to spot if coronavirus symptoms are getting worse and whether people need to be admitted to hospital.
Why is this service being recommended?
Research has shown that patients most at risk of becoming very unwell from coronavirus are best identified by oxygen levels. Because of this, the use of a pulse oximeter to monitor oxygen levels, including at home, is recommended for this group. This means that people are more likely to get the help they need as quickly as possible if their condition worsens.
Is everyone with a positive diagnosis of coronavirus eligible?
This service is being designed to support those who are most likely to benefit, which are those people who are most at risk of becoming very unwell from COVID-19. This includes people with COVID-19 who are symptomatic and have either been identified as clinically extremely vulnerable to COVID-19, or are aged 65 or older, including people in care homes. Clinical judgement can apply and take into account multiple additional COVID risk factors; for the most part, it is anticipated that this will already have led to inclusion on the CEV list. National criteria for inclusion on the CEV list are set and updated by the Government.
What oximeters should people use? Can people use their own devices or smartwatches to monitor their oxygen saturation levels?
All oximeters for home use should be CE marked and must meet the international standard (ISO 80601-2-61:2017). Some new devices such as smartwatches can measure blood oxygen levels, however, these devices are generally not medically accurate and therefore should not be used for monitoring oxygen levels of someone with coronavirus.
How will you ensure that patients have equality in access to oximeters and home monitoring?
Pulse oximetry has the potential to benefit those most at risk of coronavirus, therefore ensuring equality of access to the service from our most vulnerable patient groups is a priority. Health professionals will tailor their support to patients based on their patient’s individual circumstances, following the principles of personalised care. This includes clinicians proactively seeking to onboard patients from all groups, acknowledging that language and health literacy may sometimes be an barrier to access. Even where digital monitoring options are available, all patients will be offered an analogue (i.e. paper) alternative for monitoring in order to ensure that access to and usability of digital technology is not a barrier to accessing the service. Tailored advice will be provided to patients and any carers of those patients in order to ensure that this process is equitable and safe for all. The NHS Volunteer Responders programme may support distribution of oximeters as appropriate and where required.
Is there racial bias in pulse oximeters?
There are some studies that suggest pulse oximeters may underestimate blood oxygen levels in individuals with darker skin. Further research is required to understand the causes and implications of this, and it is not known how much this may apply to COVID-19 patients and those on COVID Oximetry @home programmes, however, it is suggested that clinicians take this into account when assessing patients. Wherever possible it is recommended that patients record a baseline oxygen saturation at onboarding, and subsequent changes in saturation readings are then compared to this established baseline. Clinicians should remain vigilant for other signs of deterioration in all patients with COVID, use their clinical judgement and monitor trends of both oxygen saturation readings and symptoms in line with published guidance.
What support and training is available for patients, carers, families to help use and interpret the oximeters?
A patient diary is available to download which includes step by step, written instructions on using an oximeter and what to do in case of concerns. This includes a paper version of a diary for monitoring but in some areas /for some patients where it is appropriate, an app may also be used. There is also an NHS film on how to use a pulse oximeter and general information available on NHS UK. Translated and easy read versions of the patient diary are available (to access latest versions of the diary and alternative versions, visit this landing page).
All local areas will need to ensure that patients entering the service, or their carers/family members where appropriate, are provided with a pulse oximeter, supporting instructional information, as well as a paper diary or suitable app / other mechanism for recording oxygen levels. They should also be provided with contact details /information on how to report oximetry reading / symptoms and clear ‘safety netting’ instructions including when to get medical help, both in and out of hours.
All patients, and/or their carers and family members, should be given information on the safe use and return of an oximeter, and if they have any concerns these should be discussed with the local clinical team.