Marty Henley

Date of Award

2011

Degree Name

Management Practice in Nurse Anesthesia

College

Graduate College

Type of Degree

DMPNA

Document Type

Research Paper

First Advisor

Dennis Emmett, Committee Chair, Lewis College of Business, Marshall University

Second Advisor

Cassy Taylor, Committee Member, CAMC School of Nurse Anesthesia

Third Advisor

Kathleen Mimnaugh, Committee Member, CAMC Physician

Abstract

Introduction: Postoperative Respiratory failure has been identified as a prevention quality indicator by The Agency for Health Research and Quality (AHRQ). Postoperative Respiratory Failure is associated with increased length of stay, increased costs and increased morbidity and mortality. Unfortunately, current research is limited regarding scoring methods which are predictive for postoperative respiratory failure. This retrospective case control study was conducted to determine if the various tools of evaluation of risk currently available and to determine if any are predictive of the risk of developing postoperative respiratory failure.

Methodology: The design of this research was a retrospective case control study conducted at CAMC. The population included a convenience sample of 111patients: 54 patients in the postoperative respiratory failure group and 57 patients in the group without postoperative respiratory failure.

Results: There were no differences in age, gender, BMI, ASA score, Surgical Apgar Score and narcotic dosing between patients who experienced no postoperative respiratory failure and patients who did experience respiratory failure. A logistic regression analysis found a statistically significant relationship between respiratory failure and 12 and 24 hour MEWS score and also Morphine PCA use postoperatively for pain control.

Discussion/Conclusion: The available risk assessment scoring systems used today, ASA score and Surgical Apgar Score are not specific enough to predict postoperative respiratory failure. In addition, neither is the diagnosis of obstructive sleep apnea or elevated BMI. Narcotic dosing during anesthesia and in the PACU did not play a significant role in the development of postoperative respiratory failure, although Morphine PCA was found to be statistically significant and these patients merit closer scrutiny in post operative monitoring. MEWS is a useful tool to identify the deteriorating patient and allow appropriate interventions to take place in a timely fashion to prevent respiratory failure. MEWS scoring should be incorporated in the nursing documentation to give nurses a tool to alert the medical staff of the deteriorating patient condition preventing respiratory failure.

Subject(s)

Anesthesiology -- Research.

Nursing -- Research.

Download

Share

COinS