SCHOLARLY PROJECT: PERIOPERATIVE CARE OF OBSTRUCTIVE SLEEP APNEA AT AN AMBULATORY SURGERY CENTER

Obstructive Sleep Apnea (OSA) is the most common sleep-related breathing disorder in the United States. OSA affects 25 million adults nationally, with as many as 80% of patients potentially undiagnosed (Hines & Marschall, 2018). Early identification with a blue wristband will increase the anesthesia providers’ awareness of OSA-related concerns for potential airway manipulation, prolonged sedation from anesthetic agents, and increased sensitivity to opioids in the post-operative period. This is a Quality Improvement (QI) project using a descriptive design to identify patients with suspected OSA on the Day of Surgery (DOS) and examine the clinical practice of providers’ administration of benzodiazepines and opioids to this patient population. The PICOT question is: In patients who are greater than or equal to 18 years old scheduled for elective surgery at an ambulatory surgical center (P), how does the implementation of a blue wristband to identify patients with diagnosed or suspected OSA (STOP-Bang score >/=4) (I) compared to current practice (C) affect the perioperative management of OSA patients as defined as receiving benzodiazepines alone or in combination with opioids (O) within the intra-operative period (T)? The project’s setting occurred at the One Day Surgery (ODS) Outpatient Center at Atrium Health. The sample for this project consisted of a total of 73 patients who either underwent elective non-cardiac surgery at CMC Atrium Health ODS from June 2022 through August 2022 or who underwent elective non-cardiac surgery from October 2022 through November 2022. The author collected data via chart review.
Inclusion criteria for Atrium Health ODS pre and post-implementation group were female and male adults older than or equal to 18 years old, scheduled for elective non-cardiac surgery, and have a STOP-Bang score >/=4. Exclusion criteria include patients younger than 18 years old, emergency surgery, Intensive Care Unit (ICU) admission, or specialized surgeries, including trauma, cardiovascular, neurological, and obstetric surgeries. To maintain the confidentiality of data, all patient data collection was de-identified, and management was completed via Excel sheets under password protection. This QI project noted a decrease in the administration of benzodiazepines by 10% in patients identified with a blue wristband, although not statistically significant.