This EBP project was generously supported, in part, by the Hawaii State Center for Nursing. This project was supported by grant number R13HS017892 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality. Don’t Ignore MY SNORE: Evidence-based Practice Management of Patients at High Risk for Obstructive Sleep Apnea (OSA) in the Perioperative Setting Presented by: Ludy P. Lemus, BSN, RN, CAPA CNIV
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This EBP project was generously supported, in part, by the Hawaii State Center for Nursing. This project was supported by grant number R13HS017892 from.
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This EBP project was generously supported, in part, by the Hawaii State Center for Nursing.This project was supported by grant number R13HS017892 from the Agency for Healthcare Research and
Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.
Don’t Ignore MY SNORE:
Evidence-based Practice Management of Patients at High Risk for Obstructive Sleep Apnea (OSA) in the
Perioperative SettingPresented by: Ludy P. Lemus, BSN, RN, CAPACNIV
ObjectivesState 3 risk factors for OSA
Gain an understanding of the process used to implement an OSA Guideline that is evidence-based into practice
OSA TeamHonorata Balinowski, RN-Project LeadHang Saito, RN-APRNBetty McMullin, RN-APRNLudy Lemus, RN-Change champion SDSCandace Hang, RN-Change champion PACUAd Hoc Members:
Alan Suyama, MD—AnesthesiaRoger Yim, MD—PulmonologistLinda Castro, RN—Sleep LabBrad Bransford--Respiratory
Identification of ProblemStudies link OSA to greater postoperative
complications
Presence of OSA associated with higher incidence of postop complicationsHypoxemiaICU transfersLonger length of stay(Kaw, et al, 2012)
At The Queen’s Medical CenterAudit Jan-Sept 2012•135 patients were identified as being high-risk•27% of those patients experienced adverse outcomes • Desaturation• EKG changes• MI• Re-intubation• ICU transfer• Death (2)secondary to
cardiopulmonary complication
Current practice (2012)
Screen for OSA in the perioperative setting STOP-Bang Tool
Initiate OSA Guideline via Nurse to Nurse Communication
Same Day SurgeryMain OR Preoperative Unit Cardiac Recovery UnitEndoscopy
Nurse-to-Nurse Communication in EMRDiagnosed or High-Risk for OSA Nursing Diagnosis: Ineffective Breathing Pattern1. Communicate OSA status2. Verify CPAP orders for patient with at-home use3. Positioning: HOB elevated/lateral4. Pulse oximetry documentation every hour for 24
hours post-anesthesia time or discharge criteria met5. Consider Capnography6. If PCA—promote bolus dosing only7. Multimodal pain control8. Discharge instructions
(OSA algorithm, 2014)
Expected Outcome Maintain airway patency
Oxygen saturation within normal limits/baseline
Pitfalls from Pilot to House-wide Small pilot population
Paper handoff not effective
FYI—High risk for OSA eliminated
SLM not available online
Smaller team
Audit SDS 8/3-8/7/2015: 190 patients
100% compliance with screening for OSAOSA guideline initiation:
67% compliance for the week100% last day of audit
87%
9%
4%
No/minimal OSA risk p=166
Diagnosed OSA p=17
STOP-Bang score 5 or greater p=7
Factors for Success Internship support and EBP advisor assigned to our team
Change champions on the unit
Identify RN not compliant for re-education
Reminders during staff huddles and email
Change communication: Paper Handoff / FYI to Nurse-to-Nurse Communication
Management support
Positive reinforcement: Raffle prizes for RN’s that implement guideline Positive safety story shared
Implications for NursesGoal: Decrease adverse cardiopulmonary
events related to OSA
Change practice based on evidence: Increase communicationVigilant monitoring Higher standard of careEducation
Plan-Do-Check-Act Audit other areas for compliance of
guideline
Formulate plan to increase compliance
Audit of patient adverse outcomes
DisseminationNursing Grand Rounds (October 2015)
AONE conference November 5 and 6, 2015-Podium
HIPAN Conference November 7, 2015-Podium
ASPAN National conference abstract submission 4/10/2016-Podium/poster
Publication Workshop January-June 2016
Special Thanks…Cindy Kamikawa-VP Nursing/ED/CNO The
Queen’s Medical Center
Renee Latimer, Director of Queen Emma Nursing Institute
Deborah Bransford, BSN- EBP advisor
Debra Mark, Director of Doctor of Nursing Practice Program at UH Manoa
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