Date of Completion

Spring 4-13-2021

Document Type

Open Access Capstone

Degree Name

Doctor of Nursing Practice (DNP)

Faculty Advisor

Eileen Stuart-Shor PhD, ANP-BC, FAHA, FAAN

Site Advisor

Jessica Shanahan MD

Second Reader

Linda Curtin PhD, RN, CCRN

Abstract

Background At the Veterans Affairs Boston, pre-operative screening for obstructive sleep apnea using the STOP-Bang questionnaire and referral to pulmonary service for those who fail screening is not reliably completed. For patients identified as having OSA or at high risk for OSA, advice on how to reduce postoperative risk may not be adequately communicated through the perioperative process. The project aim is to construct and implement a perioperative pathway to ensure surgical patients with OSA or suspected OSA receive evidence-based care throughout the perioperative period.

Methods The intervention for this quality improvement project was an evidence-based perioperative pathway which includes STOP-Bang screening, sleep study consult for high-risk individuals and supportive care. Plan-Do-Study-Act guided this project. Items measured included utilization of the perioperative pathway, preoperative referrals to pulmonary service, and improved communication throughout the perioperative services. Data was obtained from chart review and provider survey. Analysis included descriptive statistics.

Results Four hundred thirty-seven surgical patients were included in this project. Eighty four percent of surgical patients were evaluated for OSA using the OSA pathway, exceeding the benchmark of 80%. When compared to pre-implementation data, sleep study referrals doubled with the implementation of the perioperative pathway. Staff reported satisfaction with feasibility, value of care, and interdisciplinary communication.

Conclusion Implementation of the perioperative OSA pathway increased screening of patients with OSA and at risk for OSA. Utilization of the perioperative pathway led to guideline concordant OSA care across the perioperative care trajectory, increased preoperative referrals to pulmonary, and improvement in communication between services.

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