Obstructive Sleep Apnea Intervention and Treatment for Surgical Patients at Risk

Purpose:
The purpose is to establish, develop and implement the following: 1. Screening process/tool for OSA surgical patients. 2. Standard order set for patients with known/presumptive OSA. 3. On-going monitoring of the patient to include ETCO2 monitoring. 4. Sleep disorder education.

Significance:
An increase in patient safety events related to the combination of surgical procedures, obstructive sleep apnea an dhigh dose opioid use was identified. A review of the current situation demonstrated inconsistent OSA screening processes, limited monitoring tools,k and minimal treatment orders.

Strategy and Implementation:
A pilot unit was identified to trial a new OSA Screening tool, a new OSA at risk order set, and a tiered approach for treatment and monitoring. The tiered approach was implented based on the patients' individual at risk score that is calculated by the Anesthesiologist. The Anesthesiologist then completes the order set for monitoring with End Tidal CO2 and/or CPAP as the risk score indicates. A dedicated Respiratory Therapist was also implemented to support the assessment, monitoring and treatment for these at risk patients.

Evaluation:
There have been zero serious safety events from sedation or obstructive sleep apnea in the surgical patient population in the pilot. There have been zero codes outside of critical care for this surgical patient population. Patient compliance with ETCO2 and CPAP is above 90%.

Implications for Practice:
Pilot will be expanded to all surgical patients at this campus and across the OhioHealth system. Patient Safety remains paramount and this practice provides the health care clinicians with another tool to promote patient safety.