Quality improvement initiative: use of the STOP-BANG score and monitoring to reduce adverse events in hospitalised patients at risk of obstructive sleep apnoea. BMJ Open Qual 2024 Nov 27;13(4)
Date
11/29/2024Pubmed ID
39608972Pubmed Central ID
PMC11603732DOI
10.1136/bmjoq-2024-002968Scopus ID
2-s2.0-85211239870 (requires institutional sign-in at Scopus site)Abstract
BACKGROUND: Obstructive sleep apnoea increases risk of respiratory depression with administration of sedatives, narcotics or anxiolytics. To reduce adverse events during hospital admission, we implemented STOP-BANG screening to prompt respiratory monitoring for inpatients receiving these medications. This study reports on protocol development, implementation and an initial analysis over 5 years to evaluate implementation success and outcomes.
INTERVENTION: The STOP-BANG measure was embedded in the nurse navigator at admission. If the score was ≥3 and sedatives, narcotics and/or anxiolytics were ordered, the provider was prompted to monitor patients with continuous pulse oximetry and/or capnography.
METHODS: We assessed the impact of the intervention using a retrospective pre-post design. Preprotocol data from all adult inpatients over a 2.5-year period, and postprotocol data from all adult inpatients from over a 5-year period, were extracted from the electronic health record. Outcomes included use of monitoring; adverse events during hospitalisation were included to evaluate the effects of the intervention: mortality, rate of rapid response team events, reversal and/or rescue, intensive care unit admission and orders for positive airway pressure equipment.
RESULTS: The combined preprotocol and postprotocol sample included 254 121 patients. After protocol implementation, overall mortality for patients receiving sedatives, narcotics or anxiolytics decreased slightly from 2.1% to 1.9% (p<0.001). In the postprotocol cohort only (n=193 744), monitored patients had a higher probability of experiencing all adverse events. Among monitored patients, mortality was lowest in the high-risk group (STOP-BANG≥5).
DISCUSSION: Triaging by STOP-BANG coupled with monitoring appeared to be helpful for patients at highest risk of obstructive sleep apnoea. Given the complexity of obstructive sleep apnoea, further pursuit of subphenotypes is warranted.
Author List
Lauer KK, Zhang D, Lunar L, Landry C, Welter J, Flemming K, Franco R, Siclovan D, Avdeev J, Woodson BT, Szabo A, Truwit JD, Hainsworth KRAuthors
Keri Hainsworth PhD Director, Associate Professor in the Anesthesiology department at Medical College of WisconsinKathryn K. Lauer MD Vice Chair, Professor in the Anesthesiology department at Medical College of Wisconsin
Aniko Szabo PhD Professor in the Data Science Institute department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdultAged
Female
Hospitalization
Humans
Hypnotics and Sedatives
Male
Middle Aged
Monitoring, Physiologic
Oximetry
Quality Improvement
Retrospective Studies
Sleep Apnea, Obstructive
