Date of Award

Fall 12-7-2018

Degree Name

Doctor of Nursing Practice (DNP)


Leadership and Advanced Nursing Practice

Committee Chair

Dr. Bonnie L. Harbaugh, PhD, RN

Committee Chair Department


Committee Member 2

Dr. Michong Rayborn, CRNA

Committee Member 2 Department



Preoxygenation plays a vital role in ensuring patient safety for all patient populations, especially those considered clinically obese. The negative pathophysiological effects obesity has related to body habitus and respiratory mechanics increases the risk of unexpected adverse events. Obese patients encounter a 50% decrease in functional residual capacity (FRC) when undergoing general anesthesia. Dixon et al., (2005) addressed the link between efficient oxygenation and improving oxygen storage by lessening atelectasis and intrapulmonary shunting via preoxygenation in a more upright position. Can standardizing preoxygenation techniques among anesthesia providers improve patient safety and decrease hospital system’s risk by implementing an evidence-based clinical policy?

An evidence review and evaluation was conducted with six articles being used as primary references in addition to supplementary articles and scholarly textbooks. A policy was developed using strong evidence, facility procedures, and AGREE II methods. A panel of experts was formed to assist with policy review, critiques, and expert opinions. An evaluation questionnaire assessed the available knowledge on the topic, clinical relevance, and adoptability of policy in clinical practice. The data indicated members of the expert panel were willing to adopt the evidence-based clinical policy within the Anesthesiology department and deemed the policy suitable for submission to the hospital clinical policy committee.

Current evidence supports the need for elevating the head of bed during preoxygenation of obese patients undergoing general anesthesia. Anesthesia providers and operating room staff members would benefit from further education on this topic. Educational opportunities can further increase patient safety and decrease hospital system’s risk.