Date of Completion

5-1-2023

Document Type

Open Access Project

Degree Name

Doctor of Nursing Practice (DNP)

Faculty Advisor

Eileen Stuart-Shor

Site Advisor

Sharon Higgins

Second Reader

Kimberly Claude

Abstract

Background: Obstructive sleep apnea (OSA) in the perioperative period is a frequently encountered complex clinical challenge that increases the risk for post-operative complications. Patients undergoing elective orthopedic surgery may be untreated for OSA or unaware of an increased risk for OSA at the time of scheduling an elective surgical procedure. Appropriate intervention for these patients is needed to decrease the risk of postoperative complications and increased morbidity and mortality.

Methods: The objective of this improvement project was to improve the care across the perioperative experience for patients with obstructive sleep apnea or at a high risk for obstructive sleep apnea through implementation of an augmented perioperative pathway.

Intervention: An augmented perioperative pathway that included preoperative respiratory therapy referrals was implemented for patients with OSA, or at risk for OSA undergoing elective surgery in order to improve the uptake of PAP device use during the perioperative period. The project aims were evaluated using descriptive statistics. Staff satisfaction with feasibility and value added of the pathway was evaluated using qualitative, descriptive analysis. PAP utilization and respiratory referrals were tracked and descriptive statistics were used to measure improvement post implementation.

Results: Five hundred and nine elective surgical patients were included in this project. Ninety nine percent (n=506) of surgical patients identified as high risk for OSA or diagnosed with OSA were placed on the augmented OSA pathway and 95.9% (n=488) were evaluated by respiratory therapy pre-operatively, exceeding the benchmark of 90%. When compared to pre- implementation data, sleep study referrals increased by ten percent with the implementation of the augmented perioperative pathway and 98.6% (n=502) of identified patients received diagnosis specific discharge teaching. Staff reported satisfaction with feasibility, value added, and interdisciplinary communication.

Conclusion: Implementation of the augmented perioperative OSA pathway increased pre- operative respiratory therapy evaluation of patients with OSA and at risk for OSA, home sleep studies and postoperative education specific to the diagnosis of OSA. The augmented pathway was well received by staff and was deemed to be feasible, added value to the care of this patient population and improved interdisciplinary communication across the multiple communicating perioperative services.

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