Background: Oxygen therapy is a cornerstone of inpatient care, yet its safety and efficacy depend on appropriate prescription, accurate documentation, and continuous monitoring. International guidelines from the British Thoracic Society (BTS), American Association for Respiratory Care (AARC), and the World Health Organization (WHO) emphasize titrated oxygen delivery with defined target saturations to minimize risks of hypoxemia and hyperoxemia. However, compliance remains inconsistent in many healthcare settings. Objective: To evaluate the appropriateness, documentation, and monitoring of oxygen therapy in adult inpatients at Lady Reading Hospital, Peshawar, against established national and international standards. Methods: A retrospective clinical audit was conducted over three months, reviewing 220 adult inpatient records from medical and surgical wards. Patients in critical care or palliative care units were excluded. Data were extracted using a structured audit tool based on BTS, AARC, and WHO guidelines, focusing on three domains: (1) appropriateness of prescription, (2) documentation quality, and (3) monitoring adherence. Descriptive statistics were used to analyze compliance rates. Results: Appropriate indication for oxygen therapy was documented in 58.6% of cases, target saturation in 42.3%, and complete prescription documentation in 43.6%. Monitoring adherence was achieved in 52.7% of patients, while adjustments based on saturation readings were documented in only 37.7%. Overall compliance with all standards was 41.4%. Conclusion: Significant deficiencies were identified in oxygen prescription, documentation, and monitoring. Structured prescription tools, staff education, and electronic monitoring alerts are recommended to enhance compliance and improve patient safety