Abstract:
Introduction: Patients who have obstructive sleep apnea (OSA) are at higher risk for opioid-induced respiratory depression postoperatively. Many patients who have OSA are not diagnosed before having surgery and may not be monitored appropriately postoperatively.
Purpose: The purpose of this quality improvement project was to increase the number of preoperative patients screened for OSA and improve their postoperative monitoring through a novel OSA Protocol order set.
Methods: Screening for OSA risk is performed preoperatively using the STOP-Bang instrument. High-risk patients, as well as patients with existing OSA, are monitored postoperatively using a bundle of evidence-based practices to identify early respiratory compromise. If respiratory events occur, a treatment intervention will be triggered.
Outcome: Post-intervention chart reviews demonstrated 100% of the qualifying patients had OSA screening completed prior to surgery. The OSA Protocol was ordered for 28 patients. Patient harm may have been avoided through the use of continuous positive airway pressure (CPAP) triggered by actual respiratory events.
Conclusion: It is important to identify patients before surgery through preoperative screening. Identified patients should be monitored closely postoperatively for the detection of early respiratory compromise. A standing order for CPAP for patients with respiratory events can provide treatment rapidly to optimize patient outcomes. The process for monitoring high-risk patients on this postoperative unit could be considered for replication on surgical units in other hospitals.
