PURPOSE: To evaluate the effectiveness of an educational program to increase nurses’ compliance in completing a screening protocol for Obstructive Sleep Apnea (OSA) risk for preoperative orthopedic patients. Effectiveness is determined by a comparison of patient records before and after program implementation.
METHODS: This is a quasi-experimental study to evaluate an educational program to increase nurses’ compliance in following protocols in screening pre-operative inpatients for OSA. Medical records of orthopedic surgical patients are reviewed retrospectively pre and post educational program. A total of 400 medical records are selected randomly and then reviewed. Inclusion criteria are 1) Elective orthopedic surgical patients 2) Patients admitted through a short stay unit and 3) Inpatients requiring orthopedic surgery. Medically unstable patients are excluded. IRB approved.
RESULTS: Preliminary assessment of 1173/1275 (92%) nurses that completed the training show very little difference in scores pre and post education on knowledge of OSA risk. However, of the 200/200 charts reviewed from the pre-education period, results indicate nurses charted approximately only 21% of the time on OSA risk variables. The retrospective review post-education results on an additional 100/200 charts revealed that the nurses charted 40%, indicating improvement in asssesment and documentation of OSA risk.
CONCLUSION: Instituting education about a screening process by nurses for obstructive sleep apnea risk in the perioperative period is only partly successful in identifying patients at risk. The study indicates the need for detailed education and ongoing motivational efforts and reminders to improve the screening process, e.g., standardized order set that screens for OSA and prompts nurses to order sleep oximetry studies.
CLINICAL IMPLICATIONS: Knowledge of OSA risk is not a guarantee of nurses’ compliance in OSA assessment. Nursing program implementation may consider the time elements for change in practice to occur. Additionally, it is necessary to continually evaluate the documentation tools that assist nurses in screening for OSA risk. Repeating and reinforcing policy and protocol changes are essential to application of latest evidence-based practice initiatives.
DISCLOSURE: Angela Halpin, No Financial Disclosure Information; No Product/Research Disclosure Information