This article really opened my eyes and gave me food for thought. I am sure that most if not all of my patients would probably meet the criteria as set forth in this article. This is an area that gets little or no attention, yet this condition sets the stage for so many chronic and life-threatening disorders. Makes you wonder why it has taken so long for anyone to get interested in patient’s sleep, doesn’t it?
I will be more aware and observant of my patients now that I have read this article. I hope you, too, will be able to translate this information into your own practice.
By Haydn Bush
A hospital observes patients for signs of the condition and creates a care plan for those who have it.
Several years ago, Napoleon Knight, M.D., the vice president of medical affairs for Carle Foundation Hospital in Urbana, Ill., noticed that a growing number of patients admitted to the hospital were overweight. Knight began researching the connection between obesity and other medical complications, and learned that the hospital’s clinicians were encountering more patients with sleep apnea, a potentially deadly ailment in which breathing is interrupted during sleep due to blockages of the airway.
When Knight was in medical school, sleep apnea was a relatively rare condition, but its prevalence has increased in recent decades along with obesity rates. The American Association for Respiratory Care now estimates that 18 million Americans suffer from sleep apnea, which can lead to high blood pressure, cardiovascular disease, headaches and memory loss. Sleep apnea has also been linked to workplace impairment, and a 2008 study by the Vancouver Coastal Health Research Institute and the University of British Columbia found that patients with sleep apnea have double the risk of being in a car accident.
“It’s a problem that gradually crept into the environment,” Knight says.
Looking at All Patients
Undetected sleep apnea can pose a major problem for hospitals, Knight says, especially with patients who are admitted for related chronic conditions. Knight helped form a sleep apnea prevention work group at Carle Foundation Hospital, and in the summer of 2009, the group adapted a sleep apnea screening tool that had been used for bariatric surgery patients to screen the entire patient population for the condition.
At admission, staffers now ask all patients if they have already been diagnosed with sleep apnea, and those who answer yes are given continuous positive airway pressure masks to aid their breathing during their stay at the hospital.
In addition, patients who have not been diagnosed with the condition are asked a series of questions to determine if they are at risk for developing it. When patients answer yes to more than three of the questions, the hospital’s electronic medical record automatically opens a sleep apnea prevention patient care plan, which is sent directly to the patient’s nursing unit. So far, roughly 40 percent of adult patients are screening positive for sleep apnea susceptibility, according to Daniel Picchietti, M.D., a board-certified sleep medicine physician at Carle Foundation Hospital.
“That’s a huge number of patients at risk,” Picchietti says.
The patients are monitored remotely with pulse oximeters that alert unit nurses to sleep interruptions, and they are visited regularly. According to Kristina Vasnaik, R.N., a night shift nurse at the hospital and a member of the sleep apnea prevention work group, nurses are trained to quietly enter patients’ rooms while they are sleeping and watch their breathing for several minutes at a time. The work group carefully trained nurses to complete the observations without waking patients and disturbing their sleep patterns, Vasnaik says.
“There was a big education push on the protocol and what it entailed,” Vasnaik said. “We have a lot of new people on nights, and constant education is needed for them.”
Educating Patients and Doctors
The effort has proven successful; since Carle Foundation Hospital began screening for sleep apnea susceptibility, there have been no sleep apnea-related deaths at the hospital, and internal compliance with the screening process has reached 92 percent.
But the initiative doesn’t end at discharge. Patients deemed at risk of developing sleep apnea are given educational materials on the condition during their stay, and their primary care physicians are alerted to the risk. Knight says the work group plans to begin evaluating screening tools aimed at pediatric patients, who are increasingly susceptible to sleep apnea due to rising child obesity rates.
Knight also hopes to expand the initiative beyond the hospital to Carle’s outpatient affiliates, which he believes are uniquely positioned to diagnose potential sleep apnea sufferers before they land in the hospital.
“In the ideal world, this issue would be picked up in the outpatient environment before they get to the hospital,” Knight says. “All we would have to do is know they have sleep apnea.”
Knight urges all providers to research the potential impacts of obesity on their patient populations, noting that sleep apnea is one of many complications. “Once you identify it as an issue, it allows you to focus on the interventions you can put in place,” Knight says. “I look at it as a patient safety issue.”
Haydn Bush is a quality resources specialist at the AHA Quality Center.
For further information on this topic, visit www.hpoe.org.
This article 1st appeared on May 3, 2010 in HHN Magazine online site.
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