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Home Oxygen COVID Protocol

The following is a sample COVID Home Oxygen Guideline. It is posted here for general use by Emergency Departments and can be adapted to suit local needs.


Due to hospital capacity constraints, representatives from the hospitalist group, the emergency department, and senior administration met to produce these guidelines for the selection of COVID-19 patients who may safely be discharged home, directly from the ED, with home oxygen. 

  1. Clinical Criteria 
    • Patients can maintain an oxygen saturation above 90% on up to 4 liters of oxygen by nasal cannula. If a patient can normally ambulate, please check an ambulatory saturation as well. 
    • The patient is not in respiratory distress. This is a clinical decision made by the ED physician. Specifically, a respiratory rate <20 is suggested. Alternatively, consider using a scoring system like 4C or qCSI
  2. Pregnancy: A notable exception is the pregnant population. These patients should be maintained at 95% saturation. 
    • If this is possible with home O2, that is acceptable. Consult case management for assistance procuring home oxygen.
    • If case management is unable to obtain home oxygen but the patient still requires oxygen to keep saturation at 95%, they should be admitted until alternative arrangements can be made.
    • If the patient has respiratory distress but is not hypoxic, admission is still recommended (see scoring systems above)
    • The COVID team has elicited the help of OB as the primary admitting team for these patients who have a “viable fetus”, with consultation by the “COVID team”. 
  3. Pulse oximetry should be provided to patients going home on oxygen who do not have home health care set up as part of their home oxygen therapy. The hospital has procured finger pulse ox units to give COVID-19 patients going home with O2. Note: This is not a covered item by DME companies, but it is provided by home health agencies if they are involved in the patient’s care. 
  4. Home Meds: The following medications are recommended for patients being discharged home with COVID-19.
    • Vitamin C 500 mg BID (Note: Must be renally adjusted for patients with ESRD, CKD, or hx of kidney stones)
    • Vitamin D3 2000 mg Daily
    • Zinc 220 mg TID x 5 days
    • Decadron 6 mg PO daily for 10 days 
    • Inhaled Budensonide – very limited recent evidence currently for this benefit. Up to the discretion of the physician. 
  5. Anticoagulation– None unless there is another reason to provide anticoagulation. (A Fib, etc), 
  6. ED Meds
    • Regeneron-CoV should not be given to hypoxic patients. The FDA authorization is for outpatients NOT on oxygen. 
    • Remdesivir- no evidence of single dose efficacy. Also, no evidence for efficacy past 10 days from symptom onset. Up to the discretion of the physician. 
  7. If home oxygen cannot be arranged (e.g. after hours), consult the admitting hospitalist. It is fully acknowledged that there is no room for these patients in the hospital and they may spend the night in the ED even after being admitted to observation. If it is nearing daytime, consider holding in the ED until Case Management can arrange home O2 in the morning.
  8. Follow up is provided by (list clinic). This requires the ED physician to place the consult order for the (clinic). Follow up is typically provided within 72 hours and includes help with home O2 saturation monitoring, telehealth visits, oxygen titration instructions, etc.. In the reason for consultation, please enter “COVID patient home O2 follow up”.

References

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