The scene

A respiratory consultant saw a new patient with respiratory disease for the first time. At their consultation the patient requested home oxygen, telling the consultant he had tried it before and felt better with it. However, the consultant couldn't find a reference to who had prescribed this in the records, and there was no mention of home oxygen in the GP referral letter.

When questioned more closely, the patient disclosed that his son - another healthcare professional - had been supplying him with home oxygen canisters for the last year. The patient was a smoker and had documented intermittent confusion, and lived alone with some support from social services.

The consultant was concerned that correct clinical or risk assessments had not taken place before the oxygen had been prescribed or supplied, and that another practitioner had been providing the patient with oxygen (which is usually prescribed). Feeling this could pose a risk to the patient as well as the neighbouring community, given the fact that the patient had intermittent confusion, was a smoker and lived alone, the consultant rang the MDU advice line.

MDU advice

The adviser and the consultant discussed the issues at hand, especially that another healthcare professional had been inappropriately supplying oxygen to their family member. The consultant was aware how to deal with the clinical situation, but was not sure how to deal with the issue of the other healthcare professional.

In line with the GMC's guidance on raising concerns, the MDU adviser suggested the consultant tell his clinical lead about the issue involving the other practitioner so that appropriate action could be taken through the trust.

He was also advised to speak to the patient and seek consent to disclose the concern to his manager, as the sharing of information was not directly related to the patient's care.

The outcome

As a result of the conversation with the MDU's adviser, the consultant arranged for the patient to be appropriately assessed and referred him to the local home oxygen service. The consultant asked him to stop using the oxygen canister he had at home, explaining the potential risks to not only himself but also to neighbouring properties and people.

He also explained his concern about how the oxygen had been provided and that he wanted to share this with his manager, to which the patient agreed.

This dilemma is fictional but based on members' experiences and the types of calls we receive to our advice line.

Risk assessment for oxygen

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