One frequently asked question that people have about our company and our process is “Why do I need a prescription to order oxygen or CPAP?”. People after all can sometimes find these devices on eBay, on Craig’s List, and even at garage sales and flea markets. So, why does Fresh Air Medical Oxygen require prescriptions?
The fact of the matter is that oxygen and CPAP (continuous positive airway pressure) equipment are medical devices, governed and regulated by the Food and Drug Administration (FDA), as well as State Boards of Pharmacy. In fact, oxygen itself is considered a prescription drug. To get oxygen in a hospital, clinic, doctor’s office, nursing home, or even an ambulance, it requires a physician order. Typically, these institutional settings have what is called “standing orders” written by a medical director to cover the administration of oxygen.
Oxygen and CPAP are excellent therapies for people who need them, but there are sophisticated diagnostic tests that need to be performed to “titrate” (set the level or flow) for the oxygen or the CPAP. For oxygen, that test is either an arterial blood gas (ABG) or an oxygen saturation reading. ABG’s are obtained by drawing arterial blood—OUCH! Oxygen saturation readings are performed less invasively with a finger or ear pulse oximeter that fits on the finger or ear and shoots light through the skin to estimate blood oxygen levels. For CPAP, that test is the sleep study. Sleep studies are performed in labs, where patients spend a night and sleep being observed. The observation includes monitoring of heart rate and rhythm, breathing rate and depth, eye movement, limb movement, brain waves, and several other parameters. When sleep abnormalities occur, the sleep lab will gradually apply pressure (CPAP) and find the optimal level to treat the problem. Sleep studies can also be performed in the home with monitoring relayed electronically back to the lab, where a technologist and ultimately a physician, can evaluate it.
In both cases, the oxygen level and the pressure level have to be carefully titrated. Too little is not therapeutic or helpful. Too much can be a problem as well.
With oxygen, a prescription needs to include the patient’s name and how much oxygen they need. Typically, an oxygen order includes “flowrate” and “duration”. Flowrate is the amount of oxygen per minute to set the concentrator on. Duration is how many hours per day a patient needs it. An oxygen order might read:
- Oxygen at 2 Liters Per Minute (LPM) Continuously
- Oxygen at 2-4 LPM At Night
- Oxygen at 3 LPM PRN (PRN=”as needed” in terms of duration)
CPAP orders typically include the PAP device, which can be either CPAP (Continuous) or BiPAP (Bi-level—essentially two levels: one for inspiration and one for expiration). They also should include the pressure setting, which can be expressed as either a set pressure or a range. Orders for PAP look like this:
- CPAP at 8 Centimeters of Water Pressure (CWP)
- CPAP –Auto-pap 8-12 CWP
- BiPAP at 12/6 CWP
The Auto-pap feature is becoming more and more common. Rather than one set pressure level, the pressure is expressed as a range. The machine is “smart” and will assess how much pressure you need to treat the type of breathing you have every night, always within the range set by the prescription.
The good news is that the order or prescription that Fresh Air Medical Oxygen needs to dispense the equipment is a fairly simple one to obtain from the doctor. In the case of Medicare billing or some insurances, the company providing the equipment needs detailed orders that include dates of various tests and results. These are cumbersome for the physician’s office to gather. Since we are not billing any insurance companies or Medicare, we need a much simpler prescription with the information listed above on it.
If you have questions – or if you are having difficulty getting the prescription from your doctor — we can help you. We want you to get the best equipment that is most effective and designed to provide therapy at the level that matches your order. Please don’t hesitate to give our office a call if you have any questions!
Steve DeGenaro, RRT
Respiratory Therapist / Owner
Fresh Air Medical Oxygen
