Date Available

4-27-2018

Year of Publication

2018

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Melanie G. Hardin-Pierce

Clinical Mentor

Dr. David A. Hasselbacher

Committee Member

Dr. Sheila Melander

Abstract

BACKGROUND: Recent studies have found that OSA without the use of CPAP is an independent risk factor for cardiovascular disease and hypertension, which can lead to myocardial infarction (MI) and cerebral vascular accident (CVA) or stroke. This increases patient morbidity and mortality rates as well as medical costs. In those suffering from a myocardial infarction (MI) or cardiovascular accident (CVA), an important intervention is proper screening for the presence of OSA while in the acute care setting. The STOP BANG screening instrument is a simple yet effective tool in assessing for sleep apnea symptoms with a respective sensitivity of 93% for detecting moderate OSA and 100% in detecting severe OSA.

OBJECTIVE: To educate participating nursing staff on using the STOP BANG screening instrument, and implementing it within the MI and CVA populations. After completion of the implementation period, screening adherence was assessed as well as patient demographics.

METHODS: A literature review was conducted and the STOP BANG screening instrument was selected to assess for OSA. Participating nurses were educated on the use of the STOP BANG screening instrument who then implemented the tool on the MI and CVA populations. A pilot study was conducted that utilized a descriptive and qualitative study and involved a retrospective chart review that was one time only, and included a two-part study. The setting was within the ICU and 5 East Cardiac Units of Norton Brownsboro Hospital (NBH) from September 28, 2017 through December 17, 2017. RESULTS: The participation rate in the ICU was 78% and 100% in the 5 East Cardiac unit. Within the ICU a 60% screening adherence rate was achieved for CVA patients with a 40% non-adherence rate. For MI patients a 38% adherence rate was achieved for the ICU and 5 East units combined, and a 62% non-adherence rate. Among patient demographics, results were as follows: positive screens requiring supplemental oxygen was (P=.214), positive screens vs negative screens and the use of BiPAP were (P=.074) and (P=1.000), notes made in records for positive screens were 9 out of 18 or 50% adherence.

CONCLUSIONS: Nurse provider participation was high within the ICU and 5 East Cardiac units. Screening adherence was higher among the CVA patient population compared to the MI population. There was no significance or correlations between the use of supplemental oxygen or the use of BiPAP, and positive STOP BANG screens. There was statistical significance between male patients with higher BMI's and positive STOP BANG screens. These results indicate that more research is required with larger sample sizes and multiple facilities to acquire more reliable results for generalizability.

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