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Date of Award

5-5-2015

Degree Type

Restricted Evidence-Based Project Report

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

First Advisor

Theresa A. Kessler

Abstract

Patients with obstructive sleep apnea (OSA) are at increased risk for anesthesia complications, perioperative adverse outcomes, and even death. Unfortunately, 80-90% of patients afflicted with moderate-to-severe OSA are undiagnosed and unaware of their disorder; yet, they remain at increased perioperative risks. The purpose of this evidence-based practice project was to determine how implementation of an OSA screening tool and management protocol would affect perioperative outcomes and the staff members' ability to identify and manage patients at-risk from OSA. The Stetler model and Lewin's Change Theory guided the clinical practice changes. In total, 698 surgical records were reviewed, 371 pre- and 327 post-intervention. STOP-Bang questionnaire scores identified 132 of 327 participants as being at intermediate-high risk for OSA, for an estimated prevalence rate of 40.37%. In evaluation of perioperative outcomes, chi-square analyses found no significant difference between groups in the incidence of intra-operative difficult intubation or masking (χ2(1) = .922, p =.337). However, significant differences were identified between groups for both the incidence of recurrent respiratory events (RREs) in the PACU (χ2(1) = 7.672, p = .006) and the perioperative staff’s’ ability to identify/refer patients with a severe OSA diagnosis for same-day anesthesia consultation (χ2(1) = 16.102, p = .000). The preintervention group was more likely to experience a RRE, while anesthesia refer in high-risk patients was higher in the post-intervention group. Analysis of the pre-operative, intra-operative, and post-operative variable measurements showed that protocol management and compliance rates all improved in the postintervention group to 95.7%, 96.96%, and 93.94%, respectively. Results verified that implementation of this evidence-based OSA screening tool and protocol resulted in improved OSA screening and perioperative management practices. Replication of this EBP project should be considered by other healthcare organizations seeking to improve perioperative outcomes and departmental management in this high-risk patient population.

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