NR 730 Week 4 Site Implementation Plan Example

Site Implementation Plan: STOP-Bang Screening and the High-Risk Pathway at a Six-Room Ambulatory Surgery Center, by Task, Role and Date

Student Name

College of Nursing, Chamberlain University

NR 730: DNP Project

Instructor Name

Month Day, Year

Site Implementation Plan: STOP-Bang Screening and the High-Risk Pathway at a Six-Room Ambulatory Surgery Center, by Task, Role and Date

Purpose

This plan sets out how STOP-Bang screening and the high-risk pathway were put into operation at the six-room center, from approval on 14 January 2027 to the end of the data window on 26 May 2027. It is written so that someone joining the center could follow the new workflow, see who owns each piece and know what happens if something stalls. Dates already passed are marked done; the rest are commitments.

Tasks, Owners and Dates

Table 1

Implementation Tasks for Sleep Apnea Screening, With Owners and Dates

Note. Note. Owners are roles, so tasks survive staff changes. All dates are 2027.

The Workflow Before

Before the project, the preoperative phone nurse called each patient two to five days before surgery and took a medical history from a general template, which included a yes or no question about diagnosed sleep apnea. Nothing was asked about snoring, tiredness or observed breathing pauses. On the day of surgery, the admission nurse checked vital signs and consent. The anesthesiologist saw the patient in the preoperative bay a few minutes before surgery. Recovery nurses discharged patients on standard criteria, and discharge instructions were the same for everyone.

The Workflow After

Now the phone nurse asks the five STOP-Bang items that can be answered by phone: snoring, tiredness, observed apnea, high blood pressure and, from the record, body mass index and age; sex is taken from the record. On the day of surgery, the admission nurse measures neck circumference and the record completes the score, using the low, intermediate and high bands described by the tool's developers (Chung et al., 2016). A score of 5 or more turns the patient's name orange on the preoperative board, prompts the admission nurse to page the anesthesiologist with the score and loads the opioid-sparing order set as the default for that patient. In recovery, a high-risk patient stays on continuous pulse oximetry for at least 30 minutes beyond standard criteria and is discharged only after 30 minutes with no respiratory events while undisturbed. The patient goes home with sleep apnea discharge instructions, and within two business days the phone nurse writes to the patient's own clinician recommending a sleep evaluation. The pathway elements follow the anesthesia practice guideline for patients with suspected sleep apnea (American Society of Anesthesiologists Task Force, 2014).

What Patients Are Told

Patients hear about screening twice. On the phone, the nurse explains that the center now asks every adult a few questions about sleep because people with undiagnosed sleep apnea can have breathing problems after anesthesia, and that the answers help the team plan safer care. On the day of surgery, a high-risk patient and the person driving them home are told that the patient will stay a little longer in recovery for monitoring, should sleep on their side or propped up that night, should take opioid pain medicine only as prescribed and should arrange a sleep evaluation with their own clinician. The wording was reviewed by two former patients from the center's patient advisory group, who asked that the word apnea be explained the first time it is used.

Training That Covers Early Starts and Saturdays

The center has no night shift, but its first admissions arrive at 05:30 and it runs a cataract and endoscopy list on two Saturdays a month, staffed partly by per-diem nurses. Training was therefore given three ways: a 20-minute in-person session at each shift huddle in the last week of February, including two at 05:30; a six-minute recorded walkthrough of the new screens for per-diem staff, completed and signed before their next shift; and a laminated card at each admission bay showing the neck measurement and the score bands. Of 46 nurses who work at the center, 44 completed training before go-live and the other 2 before their first shift after it.

The Fidelity Check

Every Monday, the recovery charge nurse reviews the previous week's high-risk patients, about 15 to 20, and checks four things for each: score complete before surgery, anesthesia notified, order set used and extended monitoring documented. The result is a single weekly percentage of high-risk patients who received all four, shared at the Tuesday huddle. This takes about 20 minutes and is the measure that will show whether the pathway is actually delivered, which a screening rate alone cannot show.

If It Stalls

Four contingencies are written in advance. If screening completion stays below 85% for two weeks, the project lead reviews the incomplete records with the phone nurses that week, which is how the neck measurement problem was found and fixed. If the opioid-sparing order set is overridden in more than a quarter of high-risk patients, the anesthesia lead reviews the overrides at the next department meeting. If recovery bays back up because of extended monitoring, the recovery charge nurse may move a stable high-risk patient to a reclining chair with portable oximetry rather than shortening observation. And if the project lead becomes unavailable, the recovery charge nurse holds the fidelity audit and the quality coordinator holds the data pull, so the project can finish without its lead. The ambulatory consensus statement's emphasis on careful selection and opioid-sparing care for these patients (Joshi et al., 2012) is the reason no contingency allows the pathway itself to be skipped.

References

American Society of Anesthesiologists Task Force on Perioperative Management of Patients with Obstructive Sleep Apnea. (2014). Practice guidelines for the perioperative management of patients with obstructive sleep apnea. Anesthesiology, 120(2), 268-286. https://doi.org/10.1097/ALN.0000000000000053

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