For my topic I chose Obstructive Sleep Apnea (OSA) screening and the use of capnography monitoring in the post anesthesia care unit (PACU) setting. This is a subject that I can relate to and have implemented in my department. I am continually looking for best practice for caring for this increasing vulnerable population of patients.
The article I selected was from The journal of PeriAnesthesia Nursing. Implementation of Science: Incorporating Obstructive Sleep Apnea Screening and Capnography into everyday practice.
This article explored the benefit of implementing the Stop-bang questionnaire to screen patients for the risk of OSA. Mid-Atlantic Regional Center,a 927 bed hospital implemented the Stop-bang and the use of capnography in 3 of its 6 PACU’s. The result was that among 314 patients with OSA, 36% were identified as high risk. Nurses used capnography on 76% of OSA patients and were able to readily identify hypo-ventilation and intervene. Respiratory complications occurred in 10.8% requiring a higher level of care. This facility ended up implementing the screening process in all 6 of its PACU.
Scully, K. R., Rickerby, J., & Dunn, J. (2020). Implementation Science: Incorporating Obstructive Sleep Apnea Screening and Capnography Into Everyday Practice. Journal of PeriAnesthesia Nursing, 35(1), 7–16. doi: 10.1016/j.jopan.2019.06.004
Based on this study, OSA screening and capnography monitoring should be implemented into PACU units. According to Jones (2013), the status of sleep apnea, level of comorbidities, type of surgery, and anesthesia modality are risks to be considered in the guidelines and criteria of invasive surgeries. More evidence-based studies need to be conducted to aid the purpose of the OSA screenings and capnography monitoring usage in various settings.
Jones, S. F. (2013). Obstructive sleep apnea and the effects of co-existing factors on PACU stay time (Order No. 3535975). Available from Nursing & Allied Health Database. (1287070401). Retrieved from https://search-proquest-com.ezproxy.fhsu.edu/docview/1287070401?accountid=27424
There are many people with undiagnosed obstructive sleep apnea. Since these apnea and hypopnea events occur during sleep, most patients with OSA may not be aware that they have the condition. Because of the potentially serious adverse consequences associated with untreated OSA in the general and surgical population, prompt diagnosis and treatment of unrecognized OSA is critical. I had never heard of the Stop-bang questionnaire to screen patients for the risk of OSA. Several studies show that screening OSA with STOP-Bang questionnaire identifies patients with an increased incidence of postoperative complications.50, 51, 52 Data from a prospective study of 3,452 patients show that patients identified as being at high risk of OSA by the STOP-Bang questionnaire had a higher rate of postoperative complications (9% vs 2% in patients with a low risk of OSA), difficult intubation (20% vs 9%), and difficult mask ventilation (23% vs 7%).51 The STOP-Bang score was positively associated with postoperative critical care admission (Chung et al., 2016). This is a great resource in both diagnosing and treating previously unrecognized OSA.
STOP-Bang Questionnaire: A Practical Approach to Screen for Obstructive Sleep Apnea. (2016, July 21). Retrieved February 29, 2020, from https://journalclub.wustl.edu/2015/09/18/stop-bang-questionnaire-a-practical-approach-to-screen-for-obstructive-sleep-apnea/
My primary nursing experience has been in Long Term Acute Care Hospital (LTACH) majority of the patients that I have the pleasure of taking care of have some type of respiratory diagnosis which includes patients with obstructive sleep apnea. Through comprehensive assessments and testing lot of times patients aren’t diagnosed until they’re hospitalized. The diagnosis of OSA is made through different levels of nocturnal monitoring of respiratory, sleep and cardiac parameters (polysomnography or nocturnal cardio-respiratory polygraph), aimed to detect the obstructive events and the following changes in blood oxygen saturation (Therapeutic advances in chronic disease (2015).Teaching from the time these patients are admitted through discharge is essential for all patients but even more so for patients with OSA to have good out come and improve their means of breathing and oxygen circulation.
Spicuzza, L., Caruso, D., & Di Maria, G. (2015). Obstructive sleep apnoea syndrome and its management. Therapeutic advances in chronic disease, 6(5), 273–285. https://doi.org/10.1177/2040622315590318