PP-43 Shared decision making in high flow nasal oxygen therapy: a retrospective audit of practice and outcomes in an acute tertiary hospital

<h3>Introduction</h3> High Flow Nasal Oxygen Therapy (HFNO2) is a potentially life-saving intervention for patients with respiratory failure. However, communication around initiation and withdrawal have been poorly investigated in routine practice. <h3>Aims</h3> To examine documented shared decision making (SDM) relating to initiation and withdrawal of HFNO2. <h3>Methods</h3> All care episodes including Primary Procedure Code (PPC) X52.2 (HFNO2) were extracted from January 1st to June 30th 2024, from a 669-bed acute teaching hospital in England. Extracted variables included: age, sex, ethnicity, HFNO2 rationale, documented SDM, resuscitation status, symptoms and use of anticipatory medication. Time from admission to HFNO2 initiation, HFNO2 duration and time from HFNO2 withdrawal to death were calculated. <h3>Results</h3> Of 65 patients identified, 12% (n=8) were incorrectly coded and 57 patients analysed, with 74% (n=42) surviving to discharge and 26% (n=15) dying during admission. Of those surviving to discharge, 4 died within 60 days of discharge, 5 within one year (1/5 patients discharged post HFNO2, die within one year). Time from HFNO2 withdrawal to death ranged from 0 days (death on HFNO2) to 49 days, median 0.58 days. Documented SDM at HFNO2 initiation was limited, with Aims of treatment typically recorded as ‘Type-1 respiratory failure’ and little documentation around risk of treatment failure. Mean HFN02 duration was 82 hours in those who survived compared to 140 hours for those who died. 13/15 patients (87%) who died, were prescribed anticipatory medication. 12/15 (80%) had a syringe pump. Symptoms at withdrawal included breathlessness, agitation, secretions and pain; two symptomatic cases having no anticipatory medication prescribed. <h3>Conclusions</h3> This audit found a 26% inpatient mortality among patients receiving HFNO and a further 20% one year mortality for those surviving to discharge. Conversations around initiation of HFNO2 and withdrawal are poorly documented. <h3>Impact</h3> Improving HFNO2 SDM documentation could enhance patient-centred care and create opportunities for earlier advance care planning.