Improving Obstuctive Sleep Apnea Care in the Postanesthesia Care Unit.

PURPOSE: The purpose of this quality improvement project was to improve care of obstructive sleep apnea (OSA) patients through increased staff recognition of OSA in the postanesthesia care unit (PACU). DESIGN: Retrospective chart review with implementation of best practice guideline form to front of patient's chart. METHODS: Baseline data were collected during June 2020. Staff education was provided on current hospital policy of OSA patients. Implementation of a care guideline sheet was added to the front of patient charts for patients meeting inclusion criteria; it consisted of continuous pulse oximetry, 30-degree head of bed elevation, continuous positive airway pressure (CPAP) therapy, 1 hour minimum postoperative observation, nonopioid analgesics, and referral to polysomnography. A retrospective chart review was performed following the OSA guideline intervention. FINDINGS: Both pre- (N = 413) and postintervention (N = 420) groups had statistically similar demographics. CPAP use increased from 16 to 22 (t = 0.890; P = .336). The number of patients experiencing dyspnea decreased from 10 to 8 (t = 0.263; P = .608). The number of patients experiencing acute respiratory events (AREs) decreased from 24 to 18 (t = 1.012; P = .314). CONCLUSION: There were no significant statistical findings. However, increased recognition of OSA patients by PACU staff can lead to improved care alterations.

Development of the University Postoperative Obstructive Sleep Apnea Protocol (UPOP).

PURPOSE: The purpose of this project was to retrospectively analyze medical records to determine the relationship between surgical patients with obstructive sleep apnea (OSA) risk factors and the occurrence of a critical respiratory event (CRE) in the postanesthesia care unit (PACU), and to subsequently develop a protocol for postoperative care. Although OSA is prevalent among the surgical population, research has primarily focused on preoperative identification and tailored perioperative care with limited application of standardized postoperative OSA management. DESIGN: Surgical charts were retrospectively reviewed between April 1, 2019 and June 31, 2019. Medical records were reviewed to identify surgical patients who had a diagnosis of OSA or two or more OSA risk factors. For patients who met initial inclusion, PACU charts were reviewed for the occurrence of a CRE while in PACU. Data analysis involved use of both Microsoft Excel 2011 and IBM SPSS Statistics Base, version 26. METHODS: Medical records were reviewed to identify patients in PACU who had two or more documented OSA risk factors (body mass index >35, snoring, alcohol use, diabetes mellitus [DM], hypertension [HTN], or male) or a diagnosis of OSA (n = 1,361). This sample was further refined to determine the patients who had a CRE (oxygen saturation less than 92%; respiratory rate less than 10, Modified Aldrete Respiratory Score of 1 and/or lesser) while in the PACU (n = 200). FINDINGS: There was a statistically significant relationship between one CRE in the PACU and a pre-existing diagnosis of HTN, DM, snoring, alcohol use, and male gender (P < .001 for each variable). There was a statistically significant difference in body mass index between patients who experienced a CRE and those who did not (P = .004). HTN and DM (n = 16) were associated with the highest occurrence of a CRE. CONCLUSIONS: The University Postoperative Obstructive Sleep Apnea Protocol was designed based on results and current evidence-based practice. Development of a postoperative OSA protocol will positively impact patient outcomes and may reduce health care expenditures. Next steps include protocol implementation and analysis.