Proposed Topic (Most preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Authors (including presenting author) :
Tang WT, Tse PY, Ip KL, Yu HY, Chiu PH, Chow MC, Lam YF, Lo BY, Miu PL
Affiliation :
Department of Medicine, Pamela Youde Nethersole Eastern Hospital
Introduction :
OSA is associated with adverse health consequences. CPAP is the gold standard treatment. Traditionally, it is initiated after a single-night in-patient titration. Due to long waiting time and technological advancement, home CPAP titration becomes an alternative approach. However, the lack of on-site monitoring and troubleshooting support often leads to poor patient first CPAP experience, compliance and ultimately titration failure. PYNEH Sleep Centre, therefore, initiated a nurse-led "Bundle of Care" program to enhance home CPAP titration service.
Objectives :
Objective
1. To evaluate the effectiveness of bundled strategies of home CPAP titration program led by nurses in
- enhancing success rate of CPAP titration
- shortening waiting time for in-patient titration
Methodology :
Patients will attend an educational and demonstration session organized by nurses, covering OSA physiology, symptoms, mask-fitting, CPAP setup and desensitization. Patients will then use CPAP at home for 7 days. Nurses will conduct tele-monitoring and phone consultation on weekdays, tracking and analyzing CPAP usage and effectiveness data via online software. Based on patient feedback and CPAP data, guidance will be offered in addressing patients’ concern, managing side effect and providing troubleshooting support. Online tele-setting adjustment will be made by nurses to ensure patient comfort and titration accuracy. If necessary, a fast-track appointment to specialist clinic and advanced ventilation mode of titration will be arranged.
A retrospective analysis was performed to compare home titration success rate before and after program implementation. Additionally, questionnaires were administered to assess patient satisfaction.
Result & Outcome :
The program was implemented since May 2023. Total 181 Home CPAP titration were analyzed from January to August 2023 (Pre-implementation: 90; Post-implementation:91). Success rate improved from 75.5% to 90.1%. Re-titration rate dropped from 16.8% to 5.5%. The program demonstrated efficacy in reducing waiting time for in-patient titration by 20.4 weeks and 39.3 weeks for Priority 1 and 2 patients respectively (comparing January 2023 with September 2023). Feedback was overwhelmingly positive, with 94% expressing increased confidence in self-managing CPAP at home. Overall, 95% of patients were satisfied with the program.
Nurse-led “Bundle of care” – Home CPAP titration program is effective in enhancing clinical services and reducing waiting time for in-patient titration.
