ASAA Draft Guidelines for Hospital CPAP Use

[robbieh]

ASAA Draft Guidelines for Hospital CPAP Use
CPAP USE IN A HOSPITAL SETTING:
AN OBSTRUCTIVE SLEEP APNEA PATIENT’S RIGHTS AND RESPONSIBILITIES
May 5, 2007, ASAA Draft

Patient Rights:

• To be adequately treated for Obstructive Sleep Apnea (OSA) during all surgical procedures whether hospitalized or in an outpatient surgical center.

• To contact your sleep physician to get his/her assistance in resolving any sleep apnea issues while hospitalized for surgery or having outpatient surgery.

• To use your own mask and headgear, and your own equipment set at your prescribed pressure, if the facility cannot provide an identical mask and equipment with similar functionality.

• To have humidification if required and there are no medical contraindications.

Patient Responsibilities:

• To notify your physicians and caregivers that you are an OSA patient and require CPAP therapy.

• To know your prescribed pressure, mode of therapy and, if requested, providing contact information or documentation from your sleep doctor confirming your OSA diagnosis and prescribed pressure.

• To provide your own mask and headgear and, if allowed, your own CPAP or BIPAP machine. equipment.

• To label your personal equipment with your name and other identifying information.

• To notify your surgeon and anesthesiologist you are an OSA patient and require CPAP therapy, if you are having surgery.

• To inform family and/or friends that you are an OSA patient and to demonstrate to them, the purpose and parts of your equipment needed for your treatment.

• To provide medical emergency personnel with notification that you are an OSA patient, either orally or through written documentation such as a **wallet emergency information card or medical ID jewelry.


** The American Sleep Apnea Association offers such a card and a simple apnea bracelet or necklace as part of our membership package.

Also, refer to the ASAA Patient Education Bulletin posted below: “HOSPITAL CHECKLIST FOR OBSTRUCTIVE SLEEP APNEA PATIENTS”


HOSPITAL CHECKLIST FOR OBSTRUCTIVE SLEEP APNEA PATIENTS
May 5, 2007, ASAA Draft

For Obstructive Sleep Apnea (OSA) patients, there is a lot to learn about OSA and how it is treated. Patients need to understand how other events or activities can impact OSA and take any necessary steps to ensure that apnea is treated effectively. The use of CPAP therapy while hospitalized is one area of importance.

For effective treatment, OSA patients must use CPAPs anytime while sleeping. When hospitalized, many patients leave their CPAPs at home trusting that physicians and nurses will know how to manage OSA. However they often find out that hospital staff are not aware that the patient has OSA or that hospital staff are not prepared to care for OSA. Inadequate care of OSA while hospitalized can, among other things, impair healing, worsen pain and increase blood pressure, all leading to longer hospital stays and delayed recovery. Additionally, the use of narcotic pain medications and the lingering after-effects of anesthesia can make OSA worse. The following list is a guide to help OSA patients prepare for hospital stays and ensure that sleep apnea does not interfere with recovery.

This Patient Education Bulletin specifically addresses issues about CPAP while hospitalized. Many of the items listed below may also be applicable to surgical procedures done in an outpatient surgical center.

• Much of the comfort of CPAP treatment depends on using the proper mask and headgear. You are used to the mask you have been using and should be allowed to use it in the hospital.

• Ask if you can bring in your own equipment. If you are told that hospital policy dictates use of the hospital’s equipment, speak to your doctor (and to both your surgeon and the anesthesiologist if you are having surgery) to confirm the hospital’s policy and ask if the hospital has a “Permission and Release for use of Outside Medical Equipment/Appliance for Patient Treatment” form so that you can use your own equipment. Using your own equipment ensures that it has been properly set to treat your OSA. Also, many OSA patients use CPAP devices with special functions (e.g. Auto-adjusting PAP, Bilevel PAP, etc). If the hospital cannot provide a CPAP with similar features, you should be able to use your own equipment unless it is clear that different equipment will have the same benefits as your own.

• If the hospital’s policy allows you to bring in your own equipment, ask if the hospital needs to clear it before use to ensure that your equipment is functioning properly and will not be a shock or spark hazard. If your equipment does require clearance, take it in to the hospital before you are admitted. There may be a limit as to how far in advance of your admission you can have it cleared.

• Label all of your equipment, CPAP bag, mask and CPAP. When you are admitted, labels identifying you are printed for your chart and your wristband. These labels work very well to identify your equipment, so be sure to ask for extra labels.

• If hospital policy does not allow the use of outside equipment and you must use the hospital’s equipment, insist that you use your own mask to control leaks and for your own comfort. Most interfaces can be used with hospital ventilators.

• Masks usually have oxygen ports for attaching an oxygen line if it is required. If your mask does not have oxygen ports, call the manufacturer and ask if an oxygen port adapter is available for your mask. Alternately, a hose with an integrated oxygen line is most likely available at the hospital and may be used with your mask.

• Show your doctor and shift nurses, as well as family and friends who will be visiting you how to use your equipment. Reinforce the fact to them that if you are sleeping, your CPAP needs to be in use.

• If you are having surgery, tell your surgeon that you have sleep apnea and request a consultation with the anesthesiologist to discuss your OSA and how it will be managed. Tell the anesthesiologist your prescribed pressure and ask if they will need a letter from, or a consultation with, your sleep doctor.

• If your surgery involves general anesthesia you will be intubated (a breathing tube inserted into your windpipe), your CPAP will not be required during that time. However, after general anesthesia, your CPAP will be required immediately after the breathing tube comes out (extubation). Most patients are not intubated if the procedure involves sedation rather than general anesthesia. If you will be sedated during your procedure, remind the hospital staff that your CPAP needs to be available throughout the procedure.

• Immediately prior to surgery, an RN will prepare you for your procedure. During this pre-operation period, your surgeon and anesthesiologist will stop by to discuss any last-minute concerns and surgical plans. At this time, remind your surgeon and anesthesiologist that your CPAP needs to be available to you throughout all phases of surgery.

Also, refer to the ASAA Patient Education Bulletin posted above:
“CPAP USE IN A HOSPITAL SETTING: AN OBSTRUCTIVE SLEEP APNEA PATIENT’S RIGHTS AND RESPONSIBILITIES”

[tangents]

Very interesting post, Robbie. Thanks for sharing it with us.

Have a great day,
Cathy

[lvwildcat]

I found these guidelines the day they were posted on ASAA. And what perfect timing. I'm an ICU chargeRN in a big hospital in Vegas. Our hospital currently considers use of patient owned equipment TABOO. I was hospitalized in Jan;the hospital Bipap machines don't have humidifiers so I had to SNEAK in my CPAP so I could use my Oracle mask. I made a copy of these guidelines and ran them down to the hospital Risk Manager who happened to be working on a CPAP policy for patients. Like I said, PERFECT TIMING!!!!

[cpapernewbie]

I got discharged from hospital last Saturday after 4 days. This Canadian hospital allowed me to use my own CPAP device.

The RT in the hospital setup the oxygen connection (I was not allowed to do this, I get IVed in ICU with heart, oxygen and BP monitors attached to my arms)

all in all, no problem at all, just tell your RN and doctor that you are using CPAP

[LoriD]

I think they are very good outlines. When I had surgery in March, I was permitted to bring my mask and headgear, but the hospital provided the machine in the recovery room and after my surgery as well.