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COVID-19: Staff at Calgary hospitals told to ‘engage in oxygen conservation’ as cases rise

Click to play video 'Memo warns about oxygen limitations in Calgary zone' Memo warns about oxygen limitations in Calgary zone
WATCH: A memo sent to adult acute care sites in Calgary tells employees to be mindful of the use of oxygen due to limitations on bulk systems. As Jenna Freeman reports, the government says this is just predatory work as it monitors the COVID-19 situation. – Nov 30, 2020

Staff at three Calgary hospitals are being directed to be mindful of the use of oxygen for acute care patients “due to limitations of the bulk oxygen systems” and “the expected increase in demand due to the COVID-19 pandemic.”

In a letter sent to Calgary Zone adult acute care sites on Friday, Alberta Health Services said: “we need to reduce the demand on the bulk oxygen system.”

The health authority said the hospitals most impacted are the Rocky View General Hospital, Peter Lougheed Centre and Foothills Medical Centre — all of which have active COVID-19 outbreaks. The directive does not apply to patients in ICU, neonatal or pediatric care.

“Clinical measures require everyone to engage in oxygen conservation measures immediately,” the notice reads.

Read more: Increasing COVID-19 hospitalizations in Alberta pushing ICUs to 90% capacity

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Since Friday, all doctors have been assessing each patient’s oxygen requirements and updating any orders if needed, as directed in the notice. Nurses and respiratory therapists were instructed to check with their superiors to update any patient orders if needed.

“Target the lowest tolerable SpO2 [oxygen saturation],” the notice says.

Click to play video 'COVID-19: Alberta Health Services says memo asking for oxygen conservation is ‘being proactive’' COVID-19: Alberta Health Services says memo asking for oxygen conservation is ‘being proactive’
COVID-19: Alberta Health Services says memo asking for oxygen conservation is ‘being proactive’ – Nov 30, 2020

The notice says the target oxygen saturation for patients is about 90 per cent.

It also says a number of therapies are “highlighted as inappropriate” in the hospital’s patient management system, where doctors input orders and medication information for nurses.

For generic post-op patients, those restrictions include orders of continuous O2 therapy for adult patients through a nasal canula, as well as maintaining an oxygen saturation of 95 per cent with “titrate to saturation.”

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Read more: COVID-19: What does Alberta’s hospital surge plan look like?

A number of “common O2 therapy orders” are also being restricted for the time being, according to the memo, including having an oxygen saturation target of 95 per cent, with AHS saying “this should be reserved for patients with carboxy-hemogloblinemia or met-hemogloblinemia.” Staff are also asked to “avoid if possible,” making oxygen orders by device or by FiO2 [fraction of inspired oxygen].

Alberta has recorded more than 5,000 new COVID-19 infections in the past three days, with a new daily total record set on Saturday, which was then broken again on Monday.

Read more: Alberta identifying ‘unconventional ICU spaces’ as COVID-19 cases, hospitalizations rise

In an emailed statement, AHS said the Calgary Zone “has an adequate supply of oxygen to meet patient needs now and in the days ahead, as we continue to care for all patients during the COVID-19 pandemic.”

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“AHS continues to provide safe and appropriate care for all patients including those in need of oxygen therapy,” the email said.

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“The O2 monitoring and conservation memo circulated was to remind clinicians to provide oxygen therapy in an evidence-informed, responsible manner and to be proactive in safeguarding the resource recognizing that we anticipate large numbers of patients in need of oxygen therapy.”

AHS said it’s working on “proactive upgrades” to medical gas delivery systems in hospitals, as well as other ways of getting oxygen to patients, “to accommodate for potential increasing patient demands in the weeks and months ahead.”

It said the planning work has been ongoing “in the background” throughout the pandemic.

The notice to staff said AHS has a June 2021 timeline for completing the upgrades.

Click to play video 'AHS doctor says Alberta hospitals are under ‘significant strain’ amid COVID-19 pandemic' AHS doctor says Alberta hospitals are under ‘significant strain’ amid COVID-19 pandemic
AHS doctor says Alberta hospitals are under ‘significant strain’ amid COVID-19 pandemic – Nov 30, 2020

When asked about the memo Monday, Dr. Deena Hinshaw said she didn’t have details of the particular situation at the Calgary hospitals, but said COVID-19’s impact on the health-care system is “exactly why we have measures in place, and exactly why all Albertans must act to control the spread.”

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Edmonton Zone medical director Dr. David Zygun said AHS has been planning for all necessary supplies throughout the pandemic and are monitoring the oxygen situation “very frequently.”

“We’re being proactive in [the conservation] memo,” Zygun said. “Having said that, advice offered to clinicians in that memo is really an evidence-based, responsible manner that we hope all our front-line is following, and making them aware of the need for conservation,” he said.

According to Dr. Raj Bhardwaj, the majority of patients admitted to hospital with COVID-19 will need oxygen, as it’s primarily a respiratory illness.

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“What this tells me is that the numbers that we’re going to be seeing in hospital, and frankly we are seeing in hospital and the intensive care units — the numbers of people and the demands of oxygen are going to be overwhelming,” Bhardwaj said.

“And this is the sort of stuff that we talk about when we talk about flattening the curve.

“Please don’t allow health-care facilities to be overwhelmed because these are the sorts of problems we run into when they are.”

Read more: Alberta doctor calls for more restrictions, data as hospital COVID-19 outbreaks and case numbers spike

He said people need to see this kind of warning as a clear message they need to do their part to keep cases down, but said it’s “important to not be alarmist,” adding a memo like this doesn’t mean health-care workers are being told not to give a patient oxygen if they need it.

Bhardwaj said he expects to see more warnings advising health-care staff to be conscious of using things like medications and sedatives as COVID-19 hospitalizations continue to increase, similar to what has happened in New York, Spain and France.

Click to play video 'Coronavirus: Alberta records 1,733 new cases, 8 additional deaths Monday' Coronavirus: Alberta records 1,733 new cases, 8 additional deaths Monday
Coronavirus: Alberta records 1,733 new cases, 8 additional deaths Monday – Nov 30, 2020

In a news release, the Opposition NDP accused the government of lying about what it called an “oxygen shortage,” saying both Health Minister Tyler Shandro and Premier Jason Kenney “failed to prepare for the second wave of this pandemic.”

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In the legislature Monday, Shandro said there was no shortage, saying hospital staff were simply being directed to use oxygen when clinically necessary, which is not unique to the pandemic.

“A shortage of oxygen in Calgary is a truly disturbing image of an overwhelmed hospital system,” NDP health critic David Shepherd said.

“Instead of confronting this serious problem directly and honestly, Shandro lied to Albertans.

“Every day we see more Albertans infected with COVID-19 packed into our hospitals and intensive care units because Jason Kenney failed to prepare and failed to act. This oxygen shortage is the latest sign of stress from a healthcare system trying to hold back a pandemic without any meaningful help from the premier.”