Response to David Ellwanger:
To improve patient safety, we developed a protocol at Saint Francis Hospital (licensed as 918 beds) that is triggered from the nurse admit assessment - from varying admit locations. Pre-op, direct admits, Emergency Dept, etc.
The assessment poses a question to the patient (or family as appropriate) about whether they have been diagnoses with sleep apnea and prescribed a CPAP/BiPAP machine for home use.
We had lofty goals but, by virtue of the sheer volume, elected to start with the "diagnosed" osa patients, not suspected osa population.
When the patient answers in the affirmative, the protocol is "initiated." A series of patient safety strategies begin from both the Nursing Department and the Respiratory Care Dept.
Nurses place an OSA bracelet, HOB up 30+ degrees if not contraindicated, continuous pulse ox monitoring by telemetry in most circumstances, and notify physician to obtain an order.
The RT dept is notified in an automated way through our EMR system to our printer. The notification triggers our dept to take several actions. These include: assess home equipment, provide equipment if patient did not bring it to hospital, provide nightly visit to reinforce use while sleeping, and provide OSA health information handout (in english or spanish).
We started with limited telemetry equipment and have expanded our units every year to meet the needs of the protocol requirements.
Hope this helps!