Quality statement 2	All patients being assessed for home oxygen should undergo a risk assessment that includes assessment of individual and household member smoking status, and other household risks of fire, trips and falls.
Rationale	There is a significant risk of fire and personal injury by using oxygen while smoking (including e-cigarettes) or by using oxygen near a naked flame. Patients and/or household members who continue to smoke and who have access to home oxygen put themselves, other people, their surroundings, their property and neighbouring properties at risk. Home oxygen equipment and tubing can represent a trip hazard particularly for those with mobility issues or sight impairment.
Quality measure	Structure: Evidence that all patients being assessed for home oxygen undergo a holistic risk assessment that includes assessment of smoking status and other fire and falls risks before oxygen is installed. Risk assessments should take place in the patient’s place of residence and involve two-way dialogue on lifestyle. NHS England has introduced an Initial Home Oxygen Risk Mitigation Form. The information on this form is intended to raise awareness of the potential dangers of providing home oxygen and will assist healthcare professionals to make a considered decision about the appropriateness of oxygen therapy. This form can be seen in online supplementary appendix 1. Evidence that all patients being assessed for home oxygen, and their household members, are given written information regarding the increased risk associated with smoking and the use of oxygen therapy. Evidence that patients being assessed for home oxygen who smoke are offered access to a smoking cessation service. In patients where risk assessment identifies potential safety issues, patients and carers should be assessed for understanding of the risks and given opportunities to ask questions about and discuss the risks and benefits of therapy. Any decision to proceed with installation of home oxygen in the presence of significant risks should be made after careful multidisciplinary team discussion and with full understanding of the potential implications of this decision by the patient Where risk assessments identify trip and fall safety risks, restrictions (eg, providing short tubing) that might limit a patient’s independence within their home should be avoided. Where restrictions are necessary, advice and support should be provided to mitigate these.
	Process: The proportion of patients undergoing assessment for home oxygen who have undergone a holistic risk assessment. The proportion of patients who continue to smoke who have received written information regarding the increased risk associated with smoking and the use of oxygen. The proportion of patients who smoke at the time of referral for home oxygen assessment who have been referred to smoking cessation services. The proportion of patients continuing to smoke who have signed a consent form acknowledging the fire hazards of home oxygen.
	Numerator 1: The number of patients being assessed for home oxygen who have undergone a holistic risk assessment, including assessment of their and the rest of their household’s smoking status. Denominator 1: All patients being assessed for home oxygen. Numerator 2: The number of patients being assessed for home oxygen who currently smoke, or who have household members who smoke, who have been provided with written information regarding the fire hazards associated with home oxygen therapy. Denominator 2: The number of people being assessed for home oxygen who currently smoke or who have a household member who currently smokes. Numerator 3: The number of people being assessed for home oxygen who currently smoke who have been offered access to smoking cessation services. Denominator 3: The number of people being assessed for home oxygen who currently smoke.
Description of what the quality statement means for each audience	Service providers: Ensure systems are in place to identify high-risk patients. Ensure accessible referral pathways to smoking cessation services. Ensure written information is available regarding the risks associated with smoking and home oxygen therapy. Healthcare professionals: Ensure that a risk assessment is carried out as part of a home oxygen assessment. Ensure patients who continue to smoke are advised of the increased risks when home oxygen is prescribed. Ensure that patients are referred to smoking cessation services where appropriate. Commissioners: Ensure that home oxygen assessment services are adequately resourced to carry out risk assessments. Ensure that smoking cessation services are adequately resourced to meet volume of referrals. May want to consider developing a local policy for the prescribing of oxygen to patients who are known smokers. People who require home oxygen: Are made aware of the potential hazards associated with home oxygen. Who continue to smoke have been offered access to smoking cessation services.
Relevant existing indicators/data sources	For example, local data collection/audit.
Source references	BTS Guideline for Home Oxygen Use in Adults (2015).3
Other information	Home oxygen and Domestic Fires; Brendan G. Cooper, DOI: 10.1183/20734735.000815 Published 1 March 2015.4 Example domiciliary oxygen policy for patients who are known smokers: http://www.eastcheshire.nhs.uk/About-The-Trust/policies/O/Oxygen%20-%20Prescribing%20for%20Smokers%20and%20Users%20of%20E-Cigarettes%20ECT2582.pdf, https://www.blf.org.uk/support-for-you/oxygen/life-with-oxygen.