Why this work matters

Oxygen is one of the most familiar therapies in health care and one of the world’s most essential medicines. Yet published literature and clinical realities point to persistent gaps in oxygen access, knowledge, practice, monitoring, targeting, reassessment, workflow, equipment, and system readiness.

Making Oxygen Therapy Visible™ is therefore a patient-safety and workflow priority, as well as an opportunity to strengthen global oxygen resilience and climate adaptation.

  • Knowledge and practice gaps persist across settings. Studies have identified oxygen therapy knowledge and practice gaps among doctors, nurses, and emergency clinicians (Dansa et al., 2024; Desalu et al., 2022; Hassanzad et al., 2022; Tang et al., 2024; Zeleke & Kefale, 2021; Zhao et al., 2025). Structured education can help when it is practical, protocol-aligned, and connected to real clinical workflow (Diab et al., 2022; Oza et al., 2025).

  • Oxygen is essential, but it still needs a target. Oxygen should not be withheld when clinically indicated, but excessive or poorly targeted oxygen can create risk in some patients and contexts (da Silva et al., 2024; Dylla et al., 2021; O’Driscoll et al., 2016; Singer et al., 2021). Finding the right balance requires patient-specific targets, appropriate monitoring, and ongoing clinical judgement.

  • SpO₂ is important, but incomplete. Pulse oximetry is a critical assessment, but SpO₂ alone does not prove that a patient is ventilating adequately, that CO₂ is normal, that oxygen delivery is reliable, or that the underlying illness is improving. Oxygen can maintain saturation while respiratory rate rises, mental status declines, or ventilation worsens (Asdo et al., 2025; McGrath et al., 2026).

  • Respiratory rate is a high-value vital sign. It can be an early sign of deterioration, but in busy care environments, it is often omitted or estimated. The evidence supports strengthening accurate respiratory-rate measurement as a core part of patient assessment and escalation pathways (Elliott & Baird, 2019; Fieselmann et al., 1993; Palmer et al., 2023).

  • Oxygen delivery is also a system and workflow problem. Oxygen can be disrupted by transport, tubing, equipment setup, empty tanks, unclear handoffs, wrong sources, or flow being unintentionally stopped or left running (Bocknek et al., 2024; Davis & Johnston, 2008).

  • Support global oxygen resilience. Gaps in oxygen access, delivery, monitoring, equipment, and maintenance continue to contribute to preventable harm worldwide (World Health Assembly, 2023). Building resilient oxygen systems requires a coordinated ecosystem that includes reliable infrastructure and clinical training (Smith et al., 2024). Nursing involvement is increasingly recognized as essential to strengthening global oxygen system resilience (Brown et al., 2025; Rudd & Helmerhorst, 2019).

  • Climate adaptation requires oxygen-ready acute care. Climate change can worsen respiratory illness and increase pressure on acute-care services during extreme heat, wildfire smoke, and deteriorating air quality (Canadian Association of Physicians for the Environment, 2019). Health systems should act now to transform care delivery and build climate resilience (Jakobsdóttir & Haines, 2026); for oxygen care, this means ensuring therapy remains reliable, visible, and responsive during climate-related surges and operational disruptions.

Conserve Medical Technologies

Making Oxygen Therapy Visible™

The purpose of the following quiz is to help clinicians reflect on where oxygen therapy is already a professional and system strength, and where safer systems, evidence-based training, and better measurement may be needed next.

Your answers are not saved. They are used only in this browser session to calculate your result.

Disclaimer: This tool is for education and discussion. It does not replace local policy, prescriber orders, respiratory therapy guidance, emergency protocols, or patient-specific clinical judgment.

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Your grade
Making oxygen therapy visible

Bedside knowledge → Consistent unit practice → Visible Oxygen Care Site™ readiness

References

  1. Alberta Health Services. (2019). Oxygen management (Document No. HCS-111-01). Alberta Health Services.

  2. Alberta Health Services. (2022). Oxygen therapy in acute care supplemental information: Prudent use of oxygen therapy in acute care. Alberta Health Services.

  3. Alberta Health Services. (2023). Assessment and reassessment of patients (Document No. HCS-181-01). Alberta Health Services.

  4. Andersen, L. W., Berg, K. M., Chase, M., Cocchi, M. N., Massaro, J., Donnino, M. W., & American Heart Association’s Get With The Guidelines–Resuscitation Investigators. (2016). Acute respiratory compromise on inpatient wards in the United States: Incidence, outcomes, and factors associated with in-hospital mortality. Resuscitation. https://doi.org/10.1016/j.resuscitation.2016.05.014

  5. Asdo, A., Karugaba, J., Huxford, C., Dunsmuir, D., Ishebukara, I. A. A., Nagaba, P., Twongyeirwe, M., Irankunda, J., Twongirwe, C., Dumont, G., Rassool, R., Kissoon, N., Ansermino, J. M., & Businge, S. (2025). Oxygen titration for hypoxemic children in Uganda: A clinical applicability study. Preprints with The Lancet. SSRN. https://doi.org/10.2139/ssrn.5891321

  6. Bhardwaj, M., & Kashyap, S. (2022). Approach to optimal oxygen therapy in the management of COVID-19 patients during pandemic: An Indian perspective. Indian Journal of Chest Diseases and Allied Sciences, 64(2), 114–123. https://doi.org/10.5005/jp-journals-11007-0016

  7. Bocknek, L. S., Busog, D.-N. C., Ratwani, R. M., Handley, J. L., Adams, K. T., Jones, R., & Krevat, S. (2024). Unmasking the contributing factors to oxygen disruption events in the inpatient environment and emergency department. Patient Safety, 6(1), Article 117580. https://doi.org/10.33940/001c.117580

  8. Brokalaki, H., Matziou, V., Brokalaki, E., Merkouris, A., Fildissis, G., & Myrianthefs, P. (2008). Antibiotic and O2 omissions and errors in hospitalized patients. Journal of Nursing Care Quality, 23(1), 86–91.

  9. Brown, D., Birhanu, D., Lauri, M., Lubo, O., Too, P. K., Naidu, K., Ravinsdran, V., & Samor, M. (2025). Global access to medical oxygen: Embedding nursing involvement. The Lancet Global Health, 13(3), e394–e395. https://doi.org/10.1016/S2214-109X(24)00499-6

  10. Buchan, C., Khor, Y. H., Thomas, T., & Smallwood, N. (2024). Implementing oxygen therapy in medical wards—A scoping review to understand health services protocols and procedures. Journal of Clinical Medicine, 13(18), 5506. https://doi.org/10.3390/jcm13185506

  11. Canadian Association of Physicians for the Environment. (2019). Climate change toolkit for health professionals.

  12. Churpek, M. M., Snyder, A., Twu, N. M., & Edelson, D. P. (2018). Accuracy comparisons between manual and automated respiratory rate for detecting clinical deterioration in ward patients. Journal of Hospital Medicine, 13(7), 486–487. https://doi.org/10.12788/jhm.2914

  13. Colandrea, N. A., Cleary, M. L., Peaper, D. R., Sullivan, L. K., Martinello, R. A., & Murray, T. S. (2020). Oxygen nipple and nut (Christmas tree) adaptor contamination rates and decontamination with disinfecting wipes. Infection Control & Hospital Epidemiology, 41, 396–399. https://doi.org/10.1017/ice.2020.9

  14. Cousins, J. L., Wark, P. A. B., & McDonald, V. M. (2016). Acute oxygen therapy: A review of prescribing and delivery practices. International Journal of Chronic Obstructive Pulmonary Disease, 11, 1067–1075. https://doi.org/10.2147/COPD.S103607

  15. da Silva, P. B., Fernandes, S. E. S., Gomes, M., da Silveira, C. D. G., Amorim, F. F. P., Carvalho, A. L. de A., Shintaku, L. S., Miazato, L. Y., Amorim, F. F. P., Maia, M. de O., Neves, F. de A. R., & Amorim, F. F. (2024). Hyperoxemia induced by oxygen therapy in nonsurgical critically ill patients. American Journal of Critical Care, 33(2), 82–92. https://doi.org/10.4037/ajcc2024723

  16. Dansa, A., Gela, D., & Kebede, M. A. (2024). Knowledge, practice, and associated factors towards supplemental oxygen therapy among nurses working in neonatal intensive care units in public hospitals of Addis Ababa, Ethiopia, 2022: A cross-sectional study. Pediatric Health, Medicine and Therapeutics, 15, 77–86. https://doi.org/10.2147/PHMT.S445087

  17. Davis, M. M., & Johnston, J. (2008). Maintaining supplemental oxygen during transport. AJN, American Journal of Nursing, 108(1), 35–36.

  18. Desalu, O. O., Ojuawo, O. B., Adeoti, A. O., Oyedepo, O. O., Aladesanmi, A. O., Afolayan, O. J., Ibraheem, R. M., Suleiman, Z. A., & Opeyemi, C. M. (2022). Doctors’ and nurses’ knowledge and perceived barriers regarding acute oxygen therapy in a tertiary care hospital in Nigeria. Advances in Medical Education and Practice, 13, 1535–1545. https://doi.org/10.2147/AMEP.S378533

  19. Devoe, N. C., Kyriazis, P., Eltanbedawi, A., Contractor, A., Esposito, A. W., Khan, M. S., Daniel, J., & Stefan, M. S. (2021). An audit of oxygen supplementation in a large tertiary hospital—We should treat oxygen as any other drug. Hospital Practice, 49(2), 100–103. https://doi.org/10.1080/21548331.2020.1845018

  20. Diab, S. S. E. M., Ali, S. A. A., Abed, S. N., Elasrag, G. A. E. A., & Ramadan, O. M. E. (2022). Effectiveness of standardized protocol for oxygen therapy on improving nurses’ performance and patients’ health outcome. International Journal of Environmental Research and Public Health, 19(10), 5817. https://doi.org/10.3390/ijerph19105817

  21. Dylla, L., Douin, D. J., Anderson, E. L., Rice, J. D., Jackson, C. L., Bebarta, V. S., Lindsell, C. J., Cheng, A. C., Schauer, S. G., & Ginde, A. A. (2021). A multicenter cluster randomized, stepped wedge implementation trial for targeted normoxia in critically ill trauma patients: Study protocol and statistical analysis plan for the Strategy to Avoid Excessive Oxygen (SAVE-O2) trial. Trials, 22, Article 784. https://doi.org/10.1186/s13063-021-05688-6

  22. Eastwood, G. M., O’Connell, B., Gardner, A., & Considine, J. (2009). Patients’ and nurses’ perspectives on oxygen therapy: A qualitative study. Journal of Advanced Nursing, 65(3), 634–641. https://doi.org/10.1111/j.1365-2648.2008.04933.x

  23. Elliott, M., & Baird, J. (2019). Pulse oximetry and the enduring neglect of respiratory rate assessment: A commentary on patient surveillance. British Journal of Nursing, 28(19), 1156–1158.

  24. Fieselmann, J. F., Hendryx, M. S., Helms, C. M., & Wakefield, D. S. (1993). Respiratory rate predicts cardiopulmonary arrest for internal medicine inpatients. Journal of General Internal Medicine, 8(7), 354–360.

  25. Gatter, M., Dixon, G., Wall, J., & Mew, E. (2015). Changing an ingrained culture: Improving the safety of oxygen therapy at University Hospitals Bristol NHS Foundation Trust. BMJ Quality Improvement Reports, 4, u203238.w1474. https://doi.org/10.1136/bmjquality.u203238.w1474

  26. Hassanzad, M., Ghaffaripour, H., Rekabi, M., Mirzendehdel, M., Sadati, E., Elahimehr, N., & Derakhshanfar, H. (2022). Nurses’ knowledge regarding oxygen therapy; a cross-sectional study. Archives of Academic Emergency Medicine, 10(1), e38. https://doi.org/10.22037/aaem.v10i1.1553

  27. Hickey, S. (2007). An audit of oxygen therapy on a respiratory ward. British Journal of Nursing, 16(18), 1132–1136.

  28. Hill, B., & Annesley, S. H. (2020). Monitoring respiratory rate in adults. British Journal of Nursing, 29(1), 12–16.

  29. Jakobsdóttir, K., & Haines, A. (2026). Pan-European Commission on Climate and Health: Recommendations for accelerating climate action for health. The Lancet, 408(10551), 198–200. https://doi.org/10.1016/S0140-6736(26)00808-1

  30. Joseph, K. S., Ntelane, T., Lekhela, T. D., Mungati, M., Shoba, M., Montsi, S., Leluma, S. F., Oyewusi, L., Schuh, H., Hansoti, B., Mirembe, J., Shilkofski, N., Strachan, M., Mahachi, N., & McCollum, E. D. (2025). Electronic medical oxygen dashboard system for daily oxygen monitoring and stockout prevention in Lesotho. Public Health Action, 15(1), 44–46. https://doi.org/10.5588/pha.24.0046

  31. Kayser, S. A., Williamson, R., Siefert, G., Roberts, D., & Murray, A. (2023). Respiratory rate monitoring and early detection of deterioration practices. British Journal of Nursing, 32(13), 620–627.

  32. Kelly, C. (2018). Respiratory rate 1: Why measurement and recording are crucial. Nursing Times, 114(4), 23–24.

  33. Kelly, C. A., & O’Brien, M. R. (n.d.). Difficult decisions: An IPA (interpretative phenomenological analysis) study of healthcare professionals’ perceptions of oxygen therapy in palliative care.

  34. Khor, Y. H., Renzoni, E. A., Visca, D., McDonald, C. F., & Goh, N. S. L. (2019). Oxygen therapy in COPD and interstitial lung disease: Navigating the knowns and unknowns. ERJ Open Research, 5, 00118-2019. https://doi.org/10.1183/23120541.00118-2019

  35. Lee, J. H., Nathanson, L. A., Burke, R. C., Anthony, B. W., Shapiro, N. I., & Dagan, A. S. (2024). Assessment of respiratory rate monitoring in the emergency department. JACEP Open, 5, e13154. https://doi.org/10.1002/emp2.13154

  36. Leenen, J. P. L., Rasing, H. J. M., van Dijk, J. D., Kalkman, C. J., Schoonhoven, L., & Patijn, G. A. (2022). Feasibility of wireless continuous monitoring of vital signs without using alarms on a general surgical ward: A mixed methods study. PLOS ONE, 17(3), e0265435. https://doi.org/10.1371/journal.pone.0265435

  37. Lellouche, F., Bouchard, P.-A., Roberge, M., Simard, S., L’Her, E., Maltais, F., & Lacasse, Y. (2016). Automated oxygen titration and weaning with FreeO2 in patients with acute exacerbation of COPD: A pilot randomized trial. International Journal of Chronic Obstructive Pulmonary Disease, 11, 1983–1990. https://doi.org/10.2147/COPD.S112820

  38. Massaroni, C., Nicolò, A., Schena, E., & Sacchetti, M. (2020). Remote respiratory monitoring in the time of COVID-19. Frontiers in Physiology, 11, 635. https://doi.org/10.3389/fphys.2020.00635

  39. McCartan et al. (2021). The effectiveness of continuous respiratory rate monitoring in predicting hypoxic and pyrexic events. Physiological Measurement. https://doi.org/10.1088/1361-6579/ac05d5

  40. McGrath, S. P., Perreard, I. M., Blike, G. T., McGovern, K. M., Xia, X., & MacKenzie, T. (2026). Assessing the impact of supplemental oxygen use on deterioration detection in the general care setting with pulse oximetry-based continuous monitoring. Journal of Clinical Nursing, 35(6), 2734–2743. https://doi.org/10.1111/jocn.70236

  41. Medford, A., Bowen, J., & Harvey, J. (2009). Improved oxygen prescribing using a nurse-facilitated reminder. British Journal of Nursing, 18(12), 730–734.

  42. Moga, C., & Chojecki, D. (2016). Oxygen therapy in acute care settings. Institute of Health Economics.

  43. Nath, S. N. S., Nath, S., & Kumar, S. (2018). An audit of supplemental oxygen prescribing practices in an inpatient setting and its financial burden. European Respiratory Journal, 52(Suppl. 62), PA3160. https://doi.org/10.1183/13993003.congress-2018.PA3160

  44. O’Driscoll, B. R., Bakerly, N. D., Caress, A.-L., Roberts, J., Gaston, M., Newton, M., & Yorke, J. (2016). A study of attitudes, beliefs and organisational barriers related to safe emergency oxygen therapy for patients with COPD (chronic obstructive pulmonary disease) in clinical practice and research. BMJ Open Respiratory Research, 3(1), e000102. https://doi.org/10.1136/bmjresp-2015-000102

  45. O’Driscoll, B. R., Howard, L. S., Earis, J., Mak, V., & British Thoracic Society Emergency Oxygen Guideline Group. (2017). BTS guideline for oxygen use in adults in healthcare and emergency settings. Thorax, 72(Suppl. 1), i1–i90. https://doi.org/10.1136/thoraxjnl-2016-209729

  46. Oza, V., Kanabar, B., Parmar, V., Piparva, K., Patel, D., & Chauhan, J. (2025). Impact of oxygen stewardship training on knowledge and practice for oxygen administration among healthcare professionals working in the Rajkot District. Cureus, 17(5), e84152. https://doi.org/10.7759/cureus.84152

  47. Palmer, J. H., James, S., Wadsworth, D., Gordon, C. J., & Craft, J. (2023). How registered nurses are measuring respiratory rates in adult acute care health settings: An integrative review. Journal of Clinical Nursing, 32(15–16), 4515–4527. https://doi.org/10.1111/jocn.16522

  48. Pan American Health Organization. (2022). Good practices in the rational and effective use of oxygen: Preliminary document 3.1, December 2021. Washington, DC: PAHO.

  49. Piraino, T., Madden, M., Roberts, K. J., Lamberti, J., Ginier, E., & Strickland, S. L. (2022). AARC clinical practice guideline: Management of adult patients with oxygen in the acute care setting. Respiratory Care, 67(1), 115–128.

  50. Rai, J., Tay, J., Mathura, P., Damant, R., Zhang, J., Shewchuk, L., & Hirji, A. (2025). Rates of significant preventable adverse events in hospitalized patients with respiratory disease. Journal of Patient Safety, 00(00), 000–000. https://doi.org/10.1097/PTS.0000000000001441

  51. Rose, S., Sardar, S., Sasi, S., Al Mohanadi, D. H. S. H., Al-Mohammed, A. A. A. A., & Zahid, M. (2021). Time for change in practice of in-patient oxygen therapy: A period-limited, multidimensional approach to improve oxygen prescription compliance: Quality improvement project at Hamad General Hospital, Qatar. BMJ Open Quality, 10, e001574. https://doi.org/10.1136/bmjoq-2021-001574

  52. Rowland, S. D., Sharpe, H., Ferrara, G., Johannson, K. A., Kalluri, M., Thompson, S., & Stickland, M. K. (2026). Education needs in oxygen therapy for individuals with interstitial lung disease. BMJ Open Respiratory Research, 13, e004205. https://doi.org/10.1136/bmjresp-2026-004205

  53. Rowland, B., Saha, A., Motamedi, V., Bundy, R., Winsor, S., McNavish, D., Lippert, W., & Khanna, A. K. (2025). Impact on patient outcomes of continuous vital sign monitoring on medical wards: Propensity-matched analysis. Journal of Medical Internet Research, 27, e66347. https://doi.org/10.2196/66347

  54. Rudd, K. E., & Helmerhorst, H. J. F. (2019). When the tank is running low: Oxygen targets to improve patient care, reduce waste, and increase availability. Annals of the American Thoracic Society, 16(9), 1116–1117. https://doi.org/10.1513/AnnalsATS.201906-457ED

  55. Sikakulya et al. (2024). The optimal duration of continuous respiratory rate monitoring to predict in-hospital mortality within seven days of admission. Resuscitation Plus, 20, 100768.

  56. Singer, M., Young, P. J., Laffey, J. G., Asfar, P., Taccone, F. S., Skrifvars, M. B., Meyhoff, C. S., & Radermacher, P. (2021). Dangers of hyperoxia. Critical Care, 25, Article 440. https://doi.org/10.1186/s13054-021-03815-y

  57. Smallwood, N., & Holland, A. E. (2021). Over-oxygenation in the acute hospital setting: An implementation failure in need of an implementation science solution. Internal Medicine Journal, 51(5), 633–635.

  58. Smith, V., Changoor, A., Rummage, S., Wolde, H. F., Zeleke, E. G., Belay, G. M., Barash, D., Stunkel, J., & Reynolds, C. (2024). An oxygen supply is not enough: A qualitative analysis of a pressure swing adsorption oxygen plant program in Ethiopian hospitals. Global Health: Science and Practice, 12(4), e2300515. https://doi.org/10.9745/GHSP-D-23-00515

  59. Tang, N., Li, H., Zhang, J., Ling, H., Shi, L., Zhang, H., Guo, Q., & Yu, R. (2024). Nurses’ knowledge, attitude, and practice of low-flow oxygen therapy and humidification. Frontiers in Medicine, 11, Article 1460079. https://doi.org/10.3389/fmed.2024.1460079

  60. Tariq, M., Siddhantakar, A., Sherman, J. D., Cimprich, A., & Young, S. B. (2024). Life cycle assessment of medical oxygen. Journal of Cleaner Production, 444, 141126. https://doi.org/10.1016/j.jclepro.2024.141126

  61. van Noort, H. H. J., Becking-Verhaar, F. L., Bahlman-van Ooijen, W., Pel, M., van Goor, H., & Huisman-de Waal, G. (2024). Three years of continuous vital signs monitoring on the general surgical ward: Is it sustainable? A qualitative study. Journal of Clinical Medicine, 13(2), 439. https://doi.org/10.3390/jcm13020439

  62. Voepel-Lewis, T., Parker, M. L., Burke, C. N., Hemberg, J., Perlin, L., Kai, S., & Ramachandran, S. K. (2013). Pulse oximetry desaturation alarms on a general postoperative adult unit: A prospective observational study of nurse response time. International Journal of Nursing Studies, 50(10), 1351–1358. https://doi.org/10.1016/j.ijnurstu.2013.02.006

  63. Wangdi, S., Dechen, P., Dorji, K., Choden, J., Drakpa, L., Tshering, P., Tshering, K., Tshering, T., Dorji, U., & Tshering, U. (2025). Initiative to improve oxygen prescribing and oxygen delivery to patients in the emergency department of a national referral hospital. BMJ Open Quality, 14, e003132. https://doi.org/10.1136/bmjoq-2024-003132

  64. Watson, A., Mukherjee, R., Furniss, D., Higgs, J., Williamson, A., & Turner, A. (2022). A human factors approach to quality improvement in oxygen prescribing. Clinical Medicine, 22(2), 153–159. https://doi.org/10.7861/clinmed.2021-0164

  65. Wong, C., Visram, F., Cook, D., Griffith, L., Randall, J., O’Brien, B., & Higgins, D. (2000). Development, dissemination, implementation and evaluation of a clinical pathway for oxygen therapy. CMAJ, 162(1), 29–33.

  66. Wong, M., & Elliott, M. (2009). The use of medical orders in acute care oxygen therapy. British Journal of Nursing, 18(8), 462–464.

  67. World Health Assembly. (2023, May 30). Increasing access to medical oxygen (Resolution WHA76.3). World Health Organization.

  68. World Health Organization. (2020, April 4). Oxygen sources and distribution for COVID-19 treatment centres: Interim guidance. WHO/2019-nCoV/Oxygen_sources/2020.1.

  69. World Health Organization. (2023). Developing key performance indicators for the medical oxygen ecosystem through Delphi consensus, 17 February 2023. Geneva: World Health Organization.

  70. World Health Organization. (2024). Summary of WHO symposium on meeting the global needs for oxygen and respiratory care: Recent learning, current knowledge and future direction, Toronto, Canada, 4 October 2023. Geneva: World Health Organization.

  71. World Health Organization & United Nations Children’s Fund. (2019). WHO-UNICEF technical specifications and guidance for oxygen therapy devices. Geneva: World Health Organization and UNICEF.

  72. Zeleke, S., & Kefale, D. (2021). Nurses’ supplemental oxygen therapy knowledge and practice in Debre Tabor General Hospital: A cross-sectional study. Open Access Emergency Medicine, 13, 51–56. https://doi.org/10.2147/OAEM.S299139

  73. Zhao, Y., Li, L., Liu, Y., Gao, Y., & Zhang, W. (2025). Knowledge, attitudes, and practices of oxygen therapy among emergency nurses. Scientific Reports, 15, Article 27860. https://doi.org/10.1038/s41598-025-12944-1Rowland, S. D., Sharpe, H., Ferrara, G., Johannson, K. A., Kalluri, M., Thompson, S., & Stickland, M. K. (2026). Education needs in oxygen therapy for individuals with interstitial lung disease. BMJ Open Respiratory Research, 13, e004205. https://doi.org/10.1136/bmjresp-2026-004205