OR Manager - March 2019 - 12

Patient safety
Continued from page 11
STOP-Bang, Berlin, Eppworth Sleepiness
Scale (ESS), and Stop were the
tools the team evaluated based on accuracy
in predicting OSA, ease of use,
ease of implementation, cost, and current
utilization. They chose the STOPBang
questionnaire, swayed in part by a
study in the British Journal of Anesthesia
that found patients who tested positive
on this screening tool were more
likely to be diagnosed with moderate to
severe OSA (sidebar at right).
" After we chose STOP-Bang, we performed
an initial assessment of our
surgical population and found 28.5%
either had OSA or were at high risk for
moderate to severe OSA, " Cole-Ouzounian
says. " This is lower than the average
(32%), but it's still huge-prior to
this, no one was being assessed or
receiving treatment. "
STOP-Bang is owned by the University
Health Network in Toronto, Canada,
and must be purchased. At first, the
price was too steep for Sauk Prairie, but
after some negotiating, an affordable
price point was reached.
" We also needed equipment, " ColeOuzounian
says. " We worked with the
surgery center nurses, and they collected
data to see what was needed. We
needed five additional Auto-CPAP [continuous
positive airway pressure] units. "
Other steps included:
* creating an assessment and other
documentation in the electronic
medical record to support patient
care
* creating a protocol for surgical OSA
patients (sidebar, p 13)
* creating an order set and procedure
for anesthesia providers
* agreeing upon a patient identifier
* creating a standardized discharge
protocol and instructions
* developing a policy and getting approval
from the Surgery & Anesthesia
Committee.
The STOP-Bang assessment is cap12
OR
Manager | March 2019
tured within the electronic health record,
Burnley says. " The assessment
is within the preop checklist, making it
nearly impossible to miss. "
The first screening assessment was
implemented in the preoperative area
in October 2017. As of the end of June
2018, a total of 3,985 surgical patients
were screened, of which 94.9% had a
preoperative assessment completion
rate. Of those patients, 74.2% went on
to need the OSA protocol, Cole-Ouzounian
notes.
" They screened at a high rate, and
those that screened at a high rate
needed the order set: 26.7%. Of those
who had the orders placed, 42 new
postsurgical patients were required to
spend the night using CPAP. "
The screening tool was rolled out to
Sauk Prairie primary care clinics, which
now complete OSA assessments for all
physicals and all preoperative H&Ps.
" We still receive patients outside of our
primary care physician providers, and
our presurgical nurses do the screening
for those patients, " she explains.
" Sleep services is not just about
doing a sleep study, " Cole-Ouzounian
says. " You have different levels of patients
such as a new patient or a returning
patient with a level 1 to 5 service.
You can provide sleep education with a
sleep technician. You can provide initial
CPAP prescriptions or refills. It's important
for patients to come in at least annually
to have their equipment checked and
make sure it's being cleaned properly. "
Working with her director of respiratory
therapy, Cole-Ouzounian developed
a pro forma to present to senior
leadership to justify the need for sleep
services. " Sleep clinic startup costs include
staff salary and benefits, and fees
for the medical director, sleep study
interpretation, and home sleep apnea
testing interpretation, plus supplies and
variable expenses. The total cost was
$161,000, " she says. The facility had
a medical assistant and a unit secretary
who wanted more hours, so they were
assigned to work with sleep services.
" We opened on April 1 with an advanced
practice provider working three
www.ormanager.com
STOP-Bang questionnaire
Please answer the following questions by checking " yes " or " no " for each one.
Yes No
Snoring (Do you snore loudly?)
Tiredness (Do you often feel tired, fatigued, or sleepy during the daytime?)
Observed Apnea (Has anyone observed that you stop breathing,
or choke or gasp during your sleep?)
High Blood Pressure (Do you have or are you being treated for high blood pressure?)
BMI (Is your body mass index more than 35 kg per m2?)
Age (Are you older than 50 years?)
Neck Circumference (Is your neck circumference greater than 40 cm [15.75 inches]?)
Gender (Are you male?)
Score 1 point for each positive response.
Scoring interpretation: 0 to 2 = low risk, 3 or 4 = intermediate risk, ≥5 = high risk.
Source: University Health Network, Toronto, Ontario, Canada (www.stopbang.ca/
osa/screening/php). Used with permission from Sauk Prairie Healthcare.
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http://www.stopbang.ca/ http://www.ormanager.com

OR Manager - March 2019

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