Education, Teaching, and Quality Improvement |

Systematic Identification and Management of Sleep Apnea (SA) in Hospitalized Patients: Implementation of an Interprofessional Care Guideline in a Community Hospital FREE TO VIEW

Lisa Kuhen, MSN; Robyn Woidtke, RN; Christine Wynd, RN; Janet Baker, APRN-BC
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Ursuline College, Pepper Pike, OH

Chest. 2014;146(4_MeetingAbstracts):520A. doi:10.1378/chest.1992241
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SESSION TITLE: Quality & Clinical Improvement (Poster Discussion)

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Hospital prevalence of SA is estimated to be 80%, yet only 6.8% are reported (National Hospital Discharge Survey), and 5.8% of patients on home SA treatment continue treatment during hospitalization. SA puts patients at risk for adverse hospital outcomes; however, standardized screening for SA has not been widely adopted. The project goal was to enhance healthcare outcomes for hospitalized patients with and at-risk for SA by a) increasing the ability of the care team to assess and identify patients with a current diagnosis of SA, b) identify patients at risk for SA, and c) design appropriate nursing care management for same.

METHODS: The care team on a Monitored Care Unit (MCU) in a suburban community hospital in Cleveland recieved an educational intervention consisting of a) an overview of SA diagnosis, treatment and impact on patients’ health, and hospitalized patient outcomes, b) rationale for screening for SA diagnosis and hospital use of home PAP, c) use of the STOP-Bang questionnaire, and d) instruction in the use of an inter-professional evidence-based SA care management guideline. The Obstructive Sleep Apnea Knowledge and Attitudes (OSAKA) assessment was administered immediately pre/post intervention and again 30 days after care guideline implementation. Data collection will occur over a 90 day period.

RESULTS: Forty-one care team members attended the intervention, 35 completed the OSAKA, and 34/35 had an improved OSAKA score immediately post intervention. Over the first 30 day period, 38 potential patients were admitted to the MCU, 5 did not qualify, 12/33 had a STOP-Bang score < 3, 14/33 had a STOP-Bang score of >3, and 6 were identified with known SA diagnosis (5/6 used PAP therapy). One patient was not screened. Of those screened, 62.5% were at high risk for SA or had known SA. This intervention resulted in improved recognition (18.75% vs 5.5%,prior yr) of patients with known sleep apnea and improved use of home PAP therapy while hospitalized (100% vs 10%).

CONCLUSIONS: These data support the importance of rigorous SA education and a care management protocol for inter-professional hospital staff to improve the identification of SA, use of PAP therapy while hospitalized, decrease risks, and promote healing.

CLINICAL IMPLICATIONS: A gap between the literature and identification and management of SA in hospitalized patients exists. Educational intervention provides a means to bridge the SA knowledge gap to enhance healthcare outcomes in this vulnerable patient population.

DISCLOSURE: The following authors have nothing to disclose: Lisa Kuhen, Robyn Woidtke, Christine Wynd, Janet Baker

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