Nursing Assessment for Predicting Obstructive Sleep Apnea: Community Hospital Approach

Angela P. Halpin, MN, CNS, RN; Jennifer M. Bunting, AAS; Paul A. Selecky, MD; Suzette G. Bosveld, RN, BSN, MSN, CCNS, NP-C; Derrick Hong, MD

Disclosures

Topics in Advanced Practice Nursing eJournal. 2008;8(1) 

In This Article

Findings

Postintervention data were collected for this community hospital over a 6-month period. Preliminary results showed that the revised sleep assessment tool was beneficial for identifying potential and actual OSA patients. These patients received the opportunity for appropriate intervention, such as CPAP or sleep oximetry study. However, a number of patients, despite being identified and subsequently diagnosed with OSA, did not receive CPAP therapy. Review of the data revealed reasons ranging from:

  • Refusal of CPAP use by patients;

  • Communication breakdown between nurses and physicians for CPAP orders; or

  • Physicians' failure to order CPAP post communication.

The preliminary analysis post implementation at this community hospital suggests that the intervention was successful. Many patients were identified with sleep pattern disturbances and OSA on the basis of nurses' application of the evidence-based questions and criteria. If positive findings are conclusive, this study may serve as an evidence-based practice change integrated into usual nursing practice. In addition, the sleep assessment tool was able to address psychosocial issues, such as anxieties and reactions to health issues during hospitalization. This provided opportunities for the nurse to investigate other possible causes of sleep pattern disturbances and address specific patient needs.

Additional steps are needed to determine whether the identification of OSA patients using the revised sleep assessment tool minimizes or eliminates risk factors for negative health outcomes, such as myocardial infarctions and high blood pressures, at this community hospital. Planned change theory appropriately describes the general flow of implementing change; nurses were able to employ the new assessment tool to identify sleep disturbances and OSA patients.

  • Time lines must be established to target the change and adoption of new screening;

  • Collaboration should include time lines for information technology, surgical teams, respiratory departments, nursing, sleep disorders centers, and all hospital patient areas; and

  • Hospital protocols require due diligence to incorporate new interventions.

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