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Sleep Apnea: A Wake Up Call…For Nurses
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the PACU 48.286 % of the patient in Group B experienced PONV; while none experienced PONV in Group A (Chi Square 52.071,p, .001). 51.9% of Group B and 31.0% of Group A experienced PDNV at home. Discussion: This population had a high potential for PONV. Although this comparison was not statistically significant, the differences between the two groups were clinically meaningful. The intention of the investigators was to enroll 100 patients; however due to limitations encountered the statistical power may have been influenced. Conclusion: More interventions and methods are needed to decrease the incidence of PONV. The results of the study show the use of P6 stimulation in the perioperative arena is clinically meaningful. Implications: P6 stimulation is a suitable technique to prevent or treat PONV, with little or no side effects or risk to patient safety. More research on this topic is needed.
SLEEP APNEA: A WAKE UP CALL.FOR NURSES Primary Investigator: Janice Wilsey, BS, RN-BC, St. Peter’s Hospital, Albany, New York Co-Investigators: Marilyn LaParl, BS, RN-BC, Rosemarie Casale, BS, NE-BC, Lauren Adamczyk, BS, RN-BC, Andrea McCarthy, AD, RN, Theresa Legnard, BS, RN, Allison Whiting, AD, RN, Morgan Williams, AD, RN, Carole Wickham, DNS, CNS-BC
Background: Obstructive sleep apnea (OSA) is a sleep disorder with an estimated prevalence between 2% and 25% in the general population. In patients undergoing elective surgery, the prevalence is higher. Studies reveal that sedation and anesthesia increase the risk of postoperative complications. Identifying patients preoperatively to initiate appropriate interventions is prudent. Purpose: The purpose of this quantitative study was to develop and implement an interdisciplinary protocol to assist with early identification and interventions in targeted high risk OSA patients undergoing elective surgery. Methods: An evidence-based protocol was developed. Education on OSA and the protocol was provided for all direct patient caregivers. The population included patients undergoing elective colorectal and gynecologic oncology surgery over an 11 week time period. Patients who scored 3 or higher on the STOP-BANG screening tool were placed on the protocol: primary physicians were notified and results were reported to Anesthesia. Per PACU monitoring criteria, additional interventions i.e. positioning, continuous oximetry, telemetry and OSA adult analgesic orders were implemented on the surgical unit. Patient education included a video and discharge education. Results: The number of patients screened in this study was 365; 302 patients (83%) screened negative and 63 (17%) screened positive for high risk OSA. The identified 63 (17%) high risk patients were placed on the protocol. In this high risk group, protocol implementation resulted in earlier identification of events and intervention for the following high risk patients: 5 patients (8%) experienced two or more events in PACU that required cardiac and continuous pulse oximetry monitoring; 4 patients (6%) experienced two or more events in the PACU requiring C-PAP/BiPAP; 2 patients (3%) sustained oxygen desaturation below 90%; 2 patients (3%) developed arrhythmias; 23 patients (37%) had a minimum 20% change from admis-
ASPAN NATIONAL CONFERENCE ABSTRACTS sion heart rate and 32% had a minimum 20% change from admission blood pressure; none required transfer to ICU. The patients received lower analgesic doses. No reversal of analgesia was necessary. Implications: The findings are consistent with the literature. Implementation of the STOP-BANG screening tool and the protocol facilitated early identification and timely interventions. The findings suggest application to the broader surgical patient population.
A FEASIBILITY STUDY USING THE ESSENTIAL OIL LAVENDER TO REDUCE PREOPERATIVE ANXIETY IN FEMALES UNDERGOING BREAST SURGERY Primary Investigators: Maggie Colabuono, RN, BSN, CPAN, CAPA, Jackie Murauski, RN, MSN, APN, CNS, CCRN, CPAN, Patrice Stephens, RN, MSN, APN, AOCN Advocate Christ Medical Center, Oak Lawn, Illinois Co-Investigators: Dr. Adam Riker, MD, Dawn Corey, RN, Christine Danielski, RN, ADN, CAPA, Joann Quinn, RN, BSN, CAPA, Linda Sobek, RN, BSN
Introduction: Preoperative anxiety is a common finding in patients waiting to have surgery that can lead to increased physical discomfort, delayed recovery time, and need for additional medications. Perianesthesia nurses are in the unique position to manipulate the preoperative environment with aromatherapy to decrease some of this anxiety. Problem: Research shows preoperative anxiety as an issue for breast cancer patients. Studies using aromatherapy to decrease anxiety in varying populations have reported mixed results. Would inhalation of lavender aromatherapy reduce preoperative anxiety in patients awaiting breast cancer surgery? Purpose: This study sought to describe the change in anxiety score from before to after aromatherapy; compare the difference in anxiety between treatment groups; describe subject’s satisfaction with aromatherapy. Methodology: A randomized control trial of 40 breast cancer surgery patients was conducted. Anxiety was measured using the State Trait Anxiety Inventory (STAI) at three time points before surgery. Patient satisfaction was measured using a onetime self-report questionnaire. The changes in STAI score over time and between groups were tested using repeated measures analysis of variance (ANOVA). Results: Twenty subjects were in the treatment group (mean age 60611 yrs) and 19 in the control group (mean age 55610 yrs). ANOVA indicated a significant decrease in anxiety over time (F13.3, p50.000). The type of treatment had no significant effect on the anxiety scores. Yet, at 10 minutes, the treatment group declined from 45.2 to 38.7, while the control group decreased from 42.16 to 41.79. Questionnaire responses showed the treatment group was more satisfied with the use of aromatherapy and more likely to recommend the therapy to others. Discussion: Aromatherapy is an effective nursing intervention to improve preoperative patient care. The randomized controlled study design with nasal inhaler aromatherapy improves upon previous studies. Conclusion: This study provided a simple, low risk, costeffective nursing intervention using direct delivery method of lavender inhalation showing it has the potential to alleviate situational anxiety for this specific cancer population.
the PACU 48.286 % of the patient in Group B experienced PONV; while none experienced PONV in Group A (Chi Square 52.071,p, .001). 51.9% of Group B and 31.0% of Group A experienced PDNV at home. Discussion: This population had a high potential for PONV. Although this comparison was not statistically significant, the differences between the two groups were clinically meaningful. The intention of the investigators was to enroll 100 patients; however due to limitations encountered the statistical power may have been influenced. Conclusion: More interventions and methods are needed to decrease the incidence of PONV. The results of the study show the use of P6 stimulation in the perioperative arena is clinically meaningful. Implications: P6 stimulation is a suitable technique to prevent or treat PONV, with little or no side effects or risk to patient safety. More research on this topic is needed.
SLEEP APNEA: A WAKE UP CALL.FOR NURSES Primary Investigator: Janice Wilsey, BS, RN-BC, St. Peter’s Hospital, Albany, New York Co-Investigators: Marilyn LaParl, BS, RN-BC, Rosemarie Casale, BS, NE-BC, Lauren Adamczyk, BS, RN-BC, Andrea McCarthy, AD, RN, Theresa Legnard, BS, RN, Allison Whiting, AD, RN, Morgan Williams, AD, RN, Carole Wickham, DNS, CNS-BC
Background: Obstructive sleep apnea (OSA) is a sleep disorder with an estimated prevalence between 2% and 25% in the general population. In patients undergoing elective surgery, the prevalence is higher. Studies reveal that sedation and anesthesia increase the risk of postoperative complications. Identifying patients preoperatively to initiate appropriate interventions is prudent. Purpose: The purpose of this quantitative study was to develop and implement an interdisciplinary protocol to assist with early identification and interventions in targeted high risk OSA patients undergoing elective surgery. Methods: An evidence-based protocol was developed. Education on OSA and the protocol was provided for all direct patient caregivers. The population included patients undergoing elective colorectal and gynecologic oncology surgery over an 11 week time period. Patients who scored 3 or higher on the STOP-BANG screening tool were placed on the protocol: primary physicians were notified and results were reported to Anesthesia. Per PACU monitoring criteria, additional interventions i.e. positioning, continuous oximetry, telemetry and OSA adult analgesic orders were implemented on the surgical unit. Patient education included a video and discharge education. Results: The number of patients screened in this study was 365; 302 patients (83%) screened negative and 63 (17%) screened positive for high risk OSA. The identified 63 (17%) high risk patients were placed on the protocol. In this high risk group, protocol implementation resulted in earlier identification of events and intervention for the following high risk patients: 5 patients (8%) experienced two or more events in PACU that required cardiac and continuous pulse oximetry monitoring; 4 patients (6%) experienced two or more events in the PACU requiring C-PAP/BiPAP; 2 patients (3%) sustained oxygen desaturation below 90%; 2 patients (3%) developed arrhythmias; 23 patients (37%) had a minimum 20% change from admis-
ASPAN NATIONAL CONFERENCE ABSTRACTS sion heart rate and 32% had a minimum 20% change from admission blood pressure; none required transfer to ICU. The patients received lower analgesic doses. No reversal of analgesia was necessary. Implications: The findings are consistent with the literature. Implementation of the STOP-BANG screening tool and the protocol facilitated early identification and timely interventions. The findings suggest application to the broader surgical patient population.
A FEASIBILITY STUDY USING THE ESSENTIAL OIL LAVENDER TO REDUCE PREOPERATIVE ANXIETY IN FEMALES UNDERGOING BREAST SURGERY Primary Investigators: Maggie Colabuono, RN, BSN, CPAN, CAPA, Jackie Murauski, RN, MSN, APN, CNS, CCRN, CPAN, Patrice Stephens, RN, MSN, APN, AOCN Advocate Christ Medical Center, Oak Lawn, Illinois Co-Investigators: Dr. Adam Riker, MD, Dawn Corey, RN, Christine Danielski, RN, ADN, CAPA, Joann Quinn, RN, BSN, CAPA, Linda Sobek, RN, BSN
Introduction: Preoperative anxiety is a common finding in patients waiting to have surgery that can lead to increased physical discomfort, delayed recovery time, and need for additional medications. Perianesthesia nurses are in the unique position to manipulate the preoperative environment with aromatherapy to decrease some of this anxiety. Problem: Research shows preoperative anxiety as an issue for breast cancer patients. Studies using aromatherapy to decrease anxiety in varying populations have reported mixed results. Would inhalation of lavender aromatherapy reduce preoperative anxiety in patients awaiting breast cancer surgery? Purpose: This study sought to describe the change in anxiety score from before to after aromatherapy; compare the difference in anxiety between treatment groups; describe subject’s satisfaction with aromatherapy. Methodology: A randomized control trial of 40 breast cancer surgery patients was conducted. Anxiety was measured using the State Trait Anxiety Inventory (STAI) at three time points before surgery. Patient satisfaction was measured using a onetime self-report questionnaire. The changes in STAI score over time and between groups were tested using repeated measures analysis of variance (ANOVA). Results: Twenty subjects were in the treatment group (mean age 60611 yrs) and 19 in the control group (mean age 55610 yrs). ANOVA indicated a significant decrease in anxiety over time (F13.3, p50.000). The type of treatment had no significant effect on the anxiety scores. Yet, at 10 minutes, the treatment group declined from 45.2 to 38.7, while the control group decreased from 42.16 to 41.79. Questionnaire responses showed the treatment group was more satisfied with the use of aromatherapy and more likely to recommend the therapy to others. Discussion: Aromatherapy is an effective nursing intervention to improve preoperative patient care. The randomized controlled study design with nasal inhaler aromatherapy improves upon previous studies. Conclusion: This study provided a simple, low risk, costeffective nursing intervention using direct delivery method of lavender inhalation showing it has the potential to alleviate situational anxiety for this specific cancer population.