Authors (including presenting author) :
Lam MK, Chan MY, Lo EHY, Cheung JPH, Wong YW, Ling PC, Leung KSM, Chan KCH
Affiliation :
Department of Tuberculosis and Chest (DTBC), TWGHs Wong Tai Sin Hospital (WTSH)
Introduction :
Lyons (2020) revealed that, nearly 1 in 7 people was estimated to have Obstructive Sleep Apnea (OSA) worldwide. In Hong Kong, the prevalence of adulthood OSA was estimated to be > 4% in men and > 2% in women (Ip et al., 2001, 2004). There is a huge demand for sleep studies. DTBC had expanded the sleep service in KCC from October 2022. The objective of the service enhancement: (1) Strengthen governance and align clinical management protocols; (2) Increase service capacity through designation of in-lab beds and incorporation of home sleep testing; (3) Improve service quality and patient outcomes through integrated medical and nurse clinics, manual scoring and titration, and patient education. Four in-patient beds were added to tackle the long waiting time in KCC. The waiting time of elective PSG has been drastically shortened (from 2.66-3.50 years to 1-3 years) In order to increase the service quality, a 2 Tier nurse model was introduced to guarantee PSG accuracy and improve patient outcomes.
Objectives :
1. To standardise the PSG hook-up skills of DTBC nursing staff
2. To enhance quality of PSG to facilitate manual scoring and increase diagnostic accuracy
Methodology :
The enhancement project was divided into 3-phases since July 2022.
Phase (1): Sleep Training
A 5-sessions sleep training were designed for both Tier 1 (all nurses) and Tier 2 (APN or RPSGT) nurses. Tier 1 training aimed to enhance understanding of sleep services in KCC and DTBC, knowledge and skills related to sleep study. Tier 2 training aimed to align the supervision of Tier 1 nurses’ performance.
Phase (2): Skills Assessment
A manual “Adult Standard Polysomnography Procedure” was developed according to the American Academy of Sleep Medicine (AASM) standard by RPSGT in DTBC. RPSGT would conduct the assessments for all nurses who had completed the PSG training.
Phase (3): PSG Signals Checklist
PSG Signals Checklist was designed to check montages at 3 timepoints: first checking by Tier 2 staff before light off to ensure that the initial waveform and readings are all artifacts free with low impedance; second and third checking by Tier 1 staff at 0am and 3am respectively to ensure the sustainability of a high-quality PSG.
A retrospective evaluation using the PSG Signals checklist was done to compare the quality of PSG before and after the project.
Result & Outcome :
Nurses have achieved 99.8% compliance rate in skills assessment.
After the project, the percentage of achieving PSG without artifacts with low impedance has doubled (from 40% to 80%), while that of achieving a satisfactory PSG (all waveform and reading are scorable) increased from 40% to 86.7% in the initial checking. The validity of respiratory waveform and reading increased from 53.3% to 93.3% at 0am and from 43.3% to 93.3% at 3am. All participants agreed that the training was effective. They showed more confidence in performing a quality PSG. The quality of PSG has been significantly improved.
