Brief Report
Improving Provider AASM Guideline Adherence for Adult Obstructive Sleep Apnea

https://doi.org/10.1016/j.nurpra.2017.01.021Get rights and content

Highlights

  • Severity of OSA reduced from mean 16 to 5 on ESS after CPAP initiation

  • 19 (7%) of patients screened were diagnosed and treated for OSA

  • Chi-square demonstrated patients screened for OSA more likely to have OSA identified

  • $250 gain/patient diagnosed and treated first year,$64/patient each additional year

  • Protocol can be used by APRNs in primary care and specialty practices across the globe

Abstract

With an estimated 10% of the United States adult population impacted by obstructive sleep apnea (OSA), a protocol was created to increase clinical provider adherence to the American Academy of Sleep Medicine’s Clinical Guidelines for OSA. Clinic provider responsibilities included screening patients ≥ 18 years old using the Epworth Sleepiness Scale (ESS), referring patients scoring > 9 for a sleep study, educating patients diagnosed with OSA regarding disease and treatment options, prescribing treatment and short-term follow-up. After providing education and resources, 72% of patients ≥ 18 years of age were screened and 19 patients with a positive screen and OSA diagnosis had reduced OSA severity after treatment.

Section snippets

Literature

Due to lack of screening using both a thorough history and physical exam and screening protocol and the lack of provider knowledge of OSA, many patients in primary care are not being assessed for OSA, despite the number of risk factors present.2 Multiple comorbidities, such as refractory hypertension, mood disorders, obesity, gastroesophageal reflux disease, diabetes, and fatigue, have been shown to increase the likelihood a patient has OSA.2 As the number of comorbidities increases, do does

Design and Setting

This evidence-based quality improvement project was initiated at a small family practice clinic in the south-central US. Every patient ≥ 18 years old seen in the clinic during the first 4 weeks of the study participated in the project. The project was approved by the institutional review board as an exempt review.

Preintervention

A preintervention records review demonstrated that 91% of the patients had diagnoses placing them at high risk for OSA, yet none had been screened for OSA. Four of the patients had

Findings

A total of 405 eligible patients entered the practice during the 4 weeks of implementation. Of these eligible patients 293 (72%) were screened using the ESS. The percentage of patients screened each week increased by provider, with some fluctuation throughout project implementation.

During implementation, 58 (20%) patients screened had a positive ESS score, indicating possible OSA. Of the 58 patients with a positive screen, 53 (91%) were referred for a sleep study. The weekly percentage of

Limitations

Changes in providers and staff throughout the course of the project may have affected the overall screening and referral rates. Only 19 of the 53 patients referred completed a sleep study. These factors limited the total number of patients receiving an OSA diagnosis.

Implications for Advanced Practice Registered Nurses

Having a protocol in place to address OSA in primary care can serve as a viable method for identification of patients at increased risk. Although this project was implemented in a primary-care setting, the OSA algorithm can be adapted to fit a wide variety of specialty practices treating patients with risk factors associated with OSA. Using an official OSA protocol may increase insurance reimbursement and decrease denial of benefits.

In the clinic, OSA protocol implementation demonstrated a

All authors are affiliated with the University of the Incarnate Word in San Antonio, TX. Heather M. Miles, DNP, FNP-C, is a family nurse practitioner. She can be reached at [email protected].

References (6)

  • L.J. Epstein et al.

    Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults

    J Clin Sleep Med

    (2009)
  • C.F. Kleisiaris et al.

    Assessing the risk of obstructive sleep apnoea–hypopnoea syndrome in elderly home care patients with chronic multimorbidity

    Springerplus

    (2016)
  • P.C. Elwood et al.

    Sleep disturbance and daytime sleepiness predict vascular dementia

    J Epidemiol Commun Health

    (2011)
There are more references available in the full text version of this article.

Cited by (1)

All authors are affiliated with the University of the Incarnate Word in San Antonio, TX. Heather M. Miles, DNP, FNP-C, is a family nurse practitioner. She can be reached at [email protected].

Jean Dowling Dols, PhD, RN, is an associate professor.

Holly A. DiLeo, PhD, FNP-BC, is an assistant professor.

In compliance with national ethical guidelines, the authors report no relationships with business or industry that would pose a conflict of interest.

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