实施科学：将阻塞性睡眠呼吸暂停筛查和二氧化碳描记术纳入日常实践。
Implementation Science: Incorporating Obstructive Sleep Apnea Screening and Capnography Into Everyday Practice.
机构信息
Clinical Educator Perianesthesia Care Units, Inova Fairfax Medical Campus, Falls Church, VA.
School of Nursing, George Mason University, Fairfax, VA.
出版信息
J Perianesth Nurs. 2020 Feb;35(1):7-16. doi: 10.1016/j.jopan.2019.06.004. Epub 2019 Sep 5.
PURPOSE
This article describes the implementation and maintenance of obstructive sleep apnea (OSA) screening and capnography monitoring.
DESIGN
A quality improvement project.
METHODS
A multidisciplinary team provided staff education to three perianesthesia care units. Using the STOP-Bang screening tool, five or more positive responses indicated high risk for OSA. A postanesthesia care unit audit tool tracked STOP-Bang scores, capnography use, hypoventilation events, nursing interventions, and respiratory complications.
FINDINGS
Among 314 patients with OSA, 36% were identified as high risk. Nurses used capnography on 76% of OSA patients and were able to readily identify hypoventilation and intervene. Respiratory complications occurred in 10.8% (n = 34) requiring a higher level of care. Postimplementation, all six postanesthesia care units employ this best practice.
CONCLUSIONS
Perianesthesia nurses found OSA screening and capnography easy to incorporate into nursing practice. This process can reduce respiratory complications in the surgical patient with OSA. An Evidence-Based Practice Fellowship Program facilitated this practice change.
目的
本文描述了阻塞性睡眠呼吸暂停（OSA）筛查和二氧化碳描记监测的实施和维护。
设计
质量改进项目。
方法
一个多学科团队为三个麻醉后护理单元提供员工教育。使用 STOP-Bang 筛查工具，五个或更多阳性反应表明 OSA 风险高。麻醉后护理单元审核工具跟踪 STOP-Bang 评分、二氧化碳描记术使用、通气不足事件、护理干预和呼吸并发症。
发现
在 314 例 OSA 患者中，36%被确定为高风险。护士对 76%的 OSA 患者使用二氧化碳描记术，并能够识别通气不足并进行干预。10.8%（n=34）发生呼吸并发症需要更高水平的护理。实施后，所有六个麻醉后护理单元都采用了这一最佳实践。
结论
围手术期护士发现 OSA 筛查和二氧化碳描记术易于纳入护理实践。这一过程可以减少 OSA 手术患者的呼吸并发症。循证实践奖学金计划促进了这一实践的改变。
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