NR 730 Week 2 Project Problem Statement Example

Project Problem Statement: Unscreened Obstructive Sleep Apnea Among Adults Having Same-Day Surgery at a Freestanding Ambulatory Surgery Center

Student Name

College of Nursing, Chamberlain University

NR 730: DNP Project

Instructor Name

Month Day, Year

Project Problem Statement: Unscreened Obstructive Sleep Apnea Among Adults Having Same-Day Surgery at a Freestanding Ambulatory Surgery Center

The Population, Bounded

The population is every adult scheduled for an elective procedure under general anesthesia or monitored anesthesia care with sedation at a six-room surgery center that operates independently of any hospital, during the six months from 1 January to 30 June 2026. Patients having procedures under local anesthesia alone, and patients under 18, are excluded, because their airway risk from sedation and opioids differs. In that window, 3,412 adults met these criteria. All are discharged home the same day unless something goes wrong, which is what makes unrecognized sleep apnea a particular concern here: the period of greatest risk, after opioids and anesthetics, is spent at home without monitoring.

A Number From This Building

Three local figures define the problem, all released to the project lead as aggregate counts by the center's quality coordinator from the recovery unit's event log and the scheduling system, covering 1 January to 30 June 2026. First, no patient was screened for sleep apnea before surgery; the center had no screening process. Second, 270 of the 3,412 adults, 7.9%, had a diagnosis of obstructive sleep apnea recorded in their history. Third, 140 adults, 4.1%, had a respiratory event recorded in recovery, defined in the log as oxygen saturation below 90% on three or more readings, a respiratory rate below 8 or apnea of 10 seconds or more, or any airway intervention. Twenty-one adults, 0.6%, had an unplanned hospital transfer or admission, of which 6 were attributed in the log to respiratory causes.

The Comparison, Briefly

Sleep apnea is common and largely undiagnosed in surgical patients. In a meta-analysis of screening studies, the STOP-Bang questionnaire showed high sensitivity for moderate and severe sleep apnea in surgical populations, and the probability of severe disease rose with each additional point, from about 15% at a score of 3 to about 65% at 7 or 8 (Nagappa et al., 2015). Professional guidance recommends that adults be screened for obstructive sleep apnea before surgery so that anesthetic and postoperative care can be adjusted (Chung et al., 2016). Against that standard, a center that screens no one and records a diagnosis in 7.9% of its adults is very likely missing many patients with the condition.

Consequence in Local Currency

The consequences can be stated in this center's terms. Each respiratory event in recovery means a nurse at the bedside for interventions, often an anesthesiologist called back from another room and a longer recovery stay; the quality coordinator's records show a median recovery stay of 64 minutes overall and 118 minutes after a respiratory event. Each unplanned transfer means an ambulance, a hospital admission and an incident review. The six respiratory transfers in six months are few, but each one is a patient who came for a same-day procedure and left by ambulance. And because patients go home the same day, a patient with unrecognized sleep apnea who receives opioids for pain is sent home to sleep without monitoring, which is the scenario professional guidance on ambulatory surgery for patients with sleep apnea is most concerned about (Joshi et al., 2012).

Who Inside the Building Feels It

The problem lands on specific people. Recovery nurses manage the respiratory events, usually while caring for a second patient, and call anesthesia back from the next case. Anesthesiologists plan each anesthetic without knowing which patients are likely to have sleep apnea, so the patients who might benefit from regional techniques or fewer opioids are not identified in advance. Preoperative phone nurses already ask about medical history but have no structured question set for sleep apnea. And the patients themselves, and the family members who drive them home, receive standard discharge instructions with nothing about sleeping position or opioid caution. Each group is a reason the problem has persisted: each sees only its own part of it.

What the Center's Records Cannot Show

The baseline has limits that matter for later comparison. The event log records events in recovery, not after discharge, so respiratory problems at home the first night are invisible unless the patient returns or calls. The history field for sleep apnea depends on what patients report, so the 7.9% figure is a floor, not an estimate of true prevalence. And because no one was screened in the baseline period, there is no baseline for events among high-risk patients specifically; the comparison available later will be overall rates, not rates within risk groups.

What the Problem Is Not

Nothing here suggests that the center's clinicians mishandle patients known to have sleep apnea; those 270 patients already receive extra attention from anesthesia. It is that patients with undiagnosed sleep apnea, likely a much larger group, look like everyone else until something happens in recovery or at home. The project addresses identification and the response to it, not the treatment of sleep apnea itself, which belongs to the patient's primary care clinician and a sleep specialist.

The Aim

By 26 May 2027, at least 90% of eligible adults having procedures at the center will be screened with STOP-Bang before entering the operating room, and at least 85% of those scoring 5 or more will receive all three elements of the high-risk pathway: a documented notification to anesthesia, the opioid-sparing order set and extended recovery observation with continuous pulse oximetry. Recovery respiratory events and unplanned transfers will be tracked as outcomes, with the explicit expectation that a single quarter could easily pass without a detectable change in events this uncommon.

Why the Aim Is Written This Way

The aim is set on screening and pathway delivery, which the project can control and measure in twelve weeks, rather than on respiratory events, which are uncommon enough that a three-month change could easily be noise. A project that promised fewer events would likely be unable to show them and might be judged a failure for reasons unrelated to its design. Stating the outcome measures but not promising them keeps the project honest about what one center and one quarter can show.

Scope and Drift

This statement will be the reference for every later stage. If the intervention that runs differs from what is described here, for example if the pathway threshold changes from 5 to 4, the change will be recorded and justified rather than allowed to drift silently from the problem this statement defines.

References

Chung, F., Abdullah, H. R., & Liao, P. (2016). STOP-Bang questionnaire: A practical approach to screen for obstructive sleep apnea. Chest, 149(3), 631-638. https://doi.org/10.1378/chest.15-0903

Joshi, G. P., Ankichetty, S. P., Gan, T. J., & Chung, F. (2012). Society for Ambulatory Anesthesia consensus statement on preoperative selection of adult patients with obstructive sleep apnea scheduled for ambulatory surgery. Anesthesia & Analgesia, 115(5), 1060-1068. https://doi.org/10.1213/ANE.0b013e318269cfd7

Nagappa, M., Liao, P., Wong, J., Auckley, D., Ramachandran, S. K., Memtsoudis, S., Mokhlesi, B., & Chung, F. (2015). Validation of the STOP-Bang questionnaire as a screening tool for obstructive sleep apnea among different populations: A systematic review and meta-analysis. PLOS ONE, 10(12), Article e0143697. https://doi.org/10.1371/journal.pone.0143697