Implementation Science: Incorporating Obstructive Sleep Apnea Screening and Capnography Into Everyday Practice

Abstract

This article describes the implementation and maintenance of obstructive sleep apnea (OSA) screening and capnography monitoring. Design: A quality improvement project. Methods: A multidisciplinary team provided staff education to three perianesthesia care units. Using the STOP-Bang screening tool, five or more positive responses indicated high risk for OSA. A postanesthesia care unit audit tool tracked STOP-Bang scores, capnography use, hypoventilation events, nursing interventions, and respiratory complications. Findings: 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 hypoventilation and intervene. Respiratory complications occurred in 10.8% (n ¼ 34) requiring a higher level of care. Postimplementation, all six postanesthesia care units employ this best practice. Conclusions: Perianesthesia nurses found OSA screening and capnography easy to incorporate into nursing practice. This process can reduce respiratory complications in the surgical patient with OSA. An Evidence-Based Practice Fellowship Program facilitated this practice change.

Preventing Postoperative Opioid-Induced Respiratory Depression Through Implementation of an Enhanced Monitoring Program

“…14,15 Identification of those at risk for OSA is important, but a plan for safely monitoring patients postoperatively needs to be part of the care plan. Scully et al 16 implemented a quality improvement project in the perianesthesia care units for OSA screening with postoperative capnography monitoring for all high-risk patients. However, other risk factors for OIRD were not taken into consideration for additional patient populations where capnography monitoring could be beneficial.…”

A Nurse-Led Implementation Science Specialist Program

“…As a result, our organization has observed improvements in patient outcomes and cost savings, and the results of many of the projects have been disseminated at national conferences and in peer-reviewed publications. 10,22 However, despite the EBP Fellows program's success, 100% dissemination and sustainment of EBPs has not occurred. To promote more active diffusion of EBPs across the system, an analysis of the 34 EBP Fellows' projects was conducted in early 2021 with the aim of selecting projects for the IS specialists to implement.…”

“…The EBP Fellows program has evolved over the years, with at least 34 EBP projects completed across the health care system. As a result, our organization has observed improvements in patient outcomes and cost savings, and the results of many of the projects have been disseminated at national conferences and in peer-reviewed publications 10, 22…”

“…have demonstrated the positive effects of IS on improving patient outcomes and clinical practice and have reinforced the importance of IS programs in promoting sustainable change. [7][8][9][10] Most nurses and nurse leaders have not been trained in IS application. As an increasingly relevant science for the delivery of high-quality, cost-effective health care, 11 IS can be most impactful when nurses are educated on its processes.…”

“…A synthesis of over 500 studies by Durlak and DuPre concluded that as implementation quality increases, outcomes improve 6. Numerous nurse-led initiatives have demonstrated the positive effects of IS on improving patient outcomes and clinical practice and have reinforced the importance of IS programs in promoting sustainable change 7-10…”