Date of Award

Fall 9-28-2018

Degree Type

Doctoral Nursing Capstone Project

Degree Name

Doctor of Nursing Practice (DNP)

School

Leadership and Advanced Nursing Practice

Committee Chair

Dr. Nina McLain

Committee Chair Department

Nursing

Committee Member 2

Dr. Mary Jane Collins

Committee Member 2 Department

Nursing

Abstract

BACKGROUND: An increase in the prevalence of Obstructive Sleep Apnea is as high as 70% in the surgical population. OSA is associated with a higher incidence of complications in the perioperative setting showing the increased need for proper identification of moderate to high-riskpatients for referral to local sleep clinics. Identifying and treating OSA is an important step to improve managementof chronic diseases, decrease complications both inside and outside the perioperative setting, and reduce healthcare spending.

METHODS: The purpose of this project was to create an OSA referral program for patients undergoing general anesthesia at a hospital in Mississippi. The recommended OSA referral policy was a quality improvement project to improve the OSA referral process through policy development. The Modified Prisma 2009 Checklist of systematic review evaluation tool for quality in literature was used to analyze the recommendations in the creation of a recommended OSA referral policy. The referral program aimed to identify patients with a moderate to high-risk for OSA and refer them to local sleep medicine specialists for diagnostic testing. This project utilized a hospital located in Mississippi home to 400 inpatient beds, 18 operating rooms, and is a level II trauma center. The only accredited sleep disorder center in the State of Mississippi is located within the hospital. The sleep disorder center offers both inpatient and outpatient assessments as well as contains certified staff experts in sleep disorder medicine.

INTERVENTION: A systematic review of best practices was performed to recommend the creation of a policy for the referral of patients to local sleep clinics based on preoperative STOP-Bang Questionnaire scores. With the creation of a policy, undiagnosed OSA patients are more likely to be identified and properly treated with referral to local sleep clinics.

CONCLUSIONS: With the use of the STOP-Bang Questionnaire in place at a hospital in Mississippi, a coinciding referral policy does not currently exist for patients scoring ≥ 3 for referralto an accredited sleep center. The increased perioperative risks associated with undiagnosed and untreated OSA raises concern to support a referral policy. The increase in the referral of patients with moderate to high-risk for OSA can aid in decreasing perioperative risk and increasingthe overall health status of patients.

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