Developing an implementation plan

Obstructive Sleep Apnea: Implementation Plan Author`s Name Institution Methods of Obtaining Approval Hospital approval will be sought for the implementation of the project. Hospital approval is necessary so as to track the impact of proposed changes in the management of obstructive sleep apnea (OSA) (Butt e al., 2012). Early consultations will be sought with the relevant department and other nurses. This will ensure that a feasible plan is prepared, before seeking hospital approval. A detailed plan will be provided to the hospital administrators. This will also have signatures of the project executer, the operational administrators of the involved departments and the department head. In addition, other nursing staff members will be made aware of the proposed intervention for mild OSA. Most of these staff will have been engaged in the preparation for the project; hence will be aware of the plan beforehand. It is imperative to engage all the relevant staff to ensure smooth running of the proposed change process. The nursing staff will be engaged in an active manner. Description of the Current Problem Obstructive sleep apnea is a situation where a person has recurrent episodes of apnea, attributed to the closure or narrowing of pharyngeal airway during sleep (Kapur, 2010). The closure leads to pauses and reduction in the breathing process. This causes abrupt reduction in oxygen saturation levels leading to various complications. This implementation plan focuses on the management of OSA in adults. Currently, continuous positive airway pressure (CPAP) is a modality that is used in the treatment of advanced disease. This means that is often utilized for the treatment of OSA, when the apnea/Hypopnea index (AHI) is more than or equal to 15. OSA is regarded to as mild when the AHI ranges between 5 and 14 (Kapur, 2010). For the purposes of this implementation plan, early disease refers to mild OSA. CPAP decreases complications attributed to severe OSA. The complications of OSA include increased daytime somnolence leading to increased accidents rate and machine handling errors (Kapur, 2010). The complications also include heart related complications, chronic daytime blood pressure elevation, cerebral vascular accidents and impaired glucose tolerance due to irregular cortisol rhythm (Kapur, 2010). Viewed with these complications, it is necessary to deal with obstructive sleep apnea from an early stage, rather than wait to react after the deleterious consequences have occurred. This is in light of the high socioeconomic burden and prevalence of OSA (Kapur, 2010). This paper seeks to change the management of mild OSA, by incorporating CPAP as an additional intervention in early disease, in addition to other treatment modalities. Other treatment modalities to be incorporated include nurse initiated weight reduction and positional intervention during sleep. Mandibular advancement devices are proposed where the patient is intolerable to CPAP (Butt et al., 2012). Proposed Solution Continuous positive air pressure should be recommended for all patients presenting with the signs and symptoms of OSA. Therefore, CPAP should not only be used for moderate and severe OSA, but also for mild cases. This means that hospital/departmental policy with regards to the treatment of OSA should change. CPAP should be used even when AHI is below 15. The nurse should provide the patient with education materials/brochures on how to use the devices, and any precaution therein. Conventional nasal masks should be recommended in the use of CPAP. This plan recommends regular follow-up visits by specialist nurses on patients under CPAP. Regular follow-up by specialist nurses will increase patient satisfaction. CPAP should be used in combination with other treatment modalities, so as to improve the quality of life in mild OSA. Another intervention that should be undertaken concomitantly with CPAP is weight reduction initiated by the nursing staff. Intervention on weight reduction will principally involve nurses educating the patient, and empowering them to undertake measures to lower their Body Mass Index to a favorable level. The BMI should be lowered to less than 24 kg/m2. The nurse should educate the patient in conjunction with the physical therapy department. Nurses should avail educational materials inclusive of the necessary interventions and schedule to the patient with mild OSA. The nurse should also educate the patient on positional therapy during sleeping. Sleep studies should be performed on these patients so as to document individual improvement after positional intervention. In patients who cannot tolerate CPAP, intraoral protrusion devices should be utilized. Nonetheless, nasal pillows or Oracle oral mask are a useful alternative as a CPAP delivery method, before the use of protrusion devices. Mandibular Advancement Devices should be recommended for this subgroup of patients. These devices should be tailored to the individual patient. Evaluation should be undertaken. The device should be able to advance the mandible for at least 50 percent of the maximum protrusion. Rationale for Selecting Change There is an increasing prevalence of OSA among the general populace (Butt et al., 2012). This is associated with changing lifestyles, and with the increasing obesity and overweight cases in the society. At least 2 percent of women and 4 percent of men have OSA (Kapur, 2010). It is estimated that more than 80 percent of adults with OSA remain undiagnosed. This means that a person presenting to the hospital with signs and symptoms of OSA has surpassed this "undiagnosed" bracket, and though the patients AHI may be less than 15, early intervention will improve the quality of life. CPAP decreases cognitive impairment and sleepiness, (when gauged by subjective and objective measures) (Butt et al., 2012). It will have the same benefits in mild OSA with symptoms, and will decrease daytime somnolence and other complication. Additionally, CPAP normalizes the risk of workplace and traffic accidents. This is one of the reasons for proposing to incorporate CPAP in the management of early disease. Regular follow-up visits by a specialist nurse retain high patient satisfaction, while optimizing on health care resources (Kapur, 2010). Combination ...