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Respiratory Therapy Sleep Disorder Breathing/Nighttime CPAP/BiPAP – Adult – Inpatient [131]

Respiratory Therapy Sleep Disorder Breathing/Nighttime CPAP/BiPAP – Adult – Inpatient [131] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Inpatient Delegation Protocols



Delegation Protocol Number:   131      
 
Delegation Protocol Title: 
Respiratory Therapy Sleep Disorder Breathing / Nighttime CPAP/BiPAP ‐ Adult ‐ Inpatient 
 
Delegation Protocol Applies To: 
Adult Inpatients at UW Health 
 
Target Patient Population: 
Adult inpatients that use CPAP/BiPAP at home or who are at risk for Obstructive Sleep Apnea. 
 
Delegation Protocol Champions: 
Chris Green, MD ‐ Department of Pediatrics, Division of Pulmonary Medicine, Senior Vice President of 
Medical Affairs 
Mark Regan, MD ‐ Department of Medicine, Division of Anesthesia‐General 
 
Delegation Protocol Reviewers: 
Kristine Ostrander, RT – Respiratory Therapy 
Paula Breihan, RT – Respiratory Therapy 
 
Responsible Department: 
Respiratory Therapy 
 
Purpose Statement: 
This protocol delegates authority from the ordering provider to the Respiratory Care Practitioners (RCPs) 
or Respiratory Therapists (RTs) to place orders clearly indicated in the RT Sleep Disordered Breathing / 
Nighttime CPAP/BiPAP Algorithm.  
 
Who May Carry Out This Delegation Protocol: 
Respiratory Care Practitioners (RCPs) or Respiratory Therapists (RTs) trained in CPAP/BiPAP and in the 
use of this protocol. 
 
Guidelines for Implementation: 
1. This delegation protocol is initiated when a patient is admitted who is on nighttime CPAP/BiPAP 
prior to admission, when a provider orders initiation of nighttime CPAP/BiPAP, or obtains a score of 
4 or greater on the STOP‐Bang assessment. The RT will follow the steps outlined in the attached RT 
Sleep Disordered Breathing Nighttime CPAP/BiPAP algorithm. 
2. Precautions are to be applied for the following patient populations. 
2.1.  Patients with known cerebral spinal fluid leak, or who are status‐post esophageal or transnasal 
surgery, or patients with cranial skull fractures will not receive CPAP/BiPAP. 
2.2.  Patients with acute thoracic, lumbar, or spine injury will not have head of bed raised > 30 
degrees. 
2.3.  Patients who have an active order instructing bed to remain flat will not have head of bed 
raised 30 degrees.  
3. Respiratory Therapist will place orders.  The RT is able to act on the orders prior to cosign. 
  
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

Order Mode: Cosign Required, Protocol/Policy 
References:  N/A 
Collateral Documents/Tools:   
1. University Hospital Administrative Policy 8.14 – Guidelines for Administration of Continuous Invasive
and Non‐Invasive Respiratory Support
2. Validation of the Berlin Questionnaire and American Society of Anesthesiologists Checklist as Screen
Tools for Obstructive Sleep Apnea in Surgical Patients. Chung, F., Yegneswaran, B., Liao, P., Chung,
SA., Vairavanathan, S., Islam, S., Khajehdehi, A., Shapiro, CM. The American Society of
Anesthesiologist. 2008 May 108(2):822‐830.
Approved By: 
UWHC Respiratory Care Committee: October 2015 
UWHC Medical Board: January 2016 
Effective Date:  February 2016 
Scheduled for Review: February 2019 
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

T his condition is beyon d the
scope of th is algorithm
To initiate continuo us BiPAP
or CPAP on
a patient in acute respirat ory
distress, the pa tien t must be
mo ved to an IMC or IC U.
Does the pat ient use
CPAP/BiPAP at home?
Does the
pat ient require an O2
bleed in that is hig her
tha n their ho me
pre scription
at this time?
Add additio nal O2 as
ne cessary to keep Sp O2 >
88 %.
Ord er continuous oximetry
ad apted to the nur se call
syste m for pa tien t
mo nito ring with slee p and
na ps.
RT to mo nito r nighttime
CPAP/BiPAP
N o sleep
inter ven tion is
necessary.
Did the pa tien t bring
their own equ ipme nt?
Is the pa tien t’s
CPAP/BiPAP prescription
documented in Healt h Lin k?
Che ck Pt Story, Notes, and
Problem List
Star t the pa tien t on UW
eq uip m ent with the patient’s
ho me settin gs.
Ord er continuous oximetry
ad apted to the nur se call
syste m for pa tien t monitoring
with sleep an d naps.
Add additio nal O2 as
ne cessary to keep Sp O2 >
88 %. The bleed in should
no t excee d 4; if it does
conta ct the orde ring MD.
Reco mmend Pulmonar y
Consult.
R T to mo nito r nighttime
CPAP/BiPAP
Star t the pa tien t on Auto CPAP or
Auto BiPAP whichever ap plies to
th eir home prescr ip tion . CPAP min .
6 and max. 20. BiPAP min. 6 and
ma x 25 with PS 6.
Ord er continuous oximetry adap ted
to the nur se call system for patient
mo nito ring with slee p and na ps.
Add additio nal O2 as ne cessary to
keep Sp O2 > 88%.
RT to mo nito r nighttime CPAP/
BiPAP
NO
Can you an sw er yes to all
of the fo llowing?
1 )equipmen t passe s electr ical safety check.
2 )pt dem onstrates how to put the
device on and take it off.
3) pt explains proper cleaning and
has all necessar y supplies ava ilable.
U tilize th e patient’s own
eq uip m ent overn ight and nap s
bu t RT to monitor. If patient’s
eq uip m ent fails safety check,
ho spital equipmen t will be used
Ord er continuous oximetry
ad apted to the nur se call system
fo r patient mo nito ring with slee p
an d naps.
Continue to evaluate for ability to
S/A
C hange th e patient to self-
ad ministration of their
BiPAP/CPAP.
Ord er continuous oximetry
ad apted to the nur se call
syste m for pa tien t
mo nito ring with slee p and
na ps.
YES
YES
NO
D oes the pat ient
have diagn ose d OSA or
su spe cted OSA (scre ened
positive with STOP Bang)?
YES
Place the pa tien t HOB up 30 degree s at all
times Monitor patient with continuous pulse
oximetry.**
Ord er continuous oximetry adap ted to the
nu rse call system fo r patient mo nito ring with
sleep and naps.
Add additio nal O2 as ne cessary to keep
SPO2 >92% . The bleed in should not
exceed 4 LPM. If it does, RT will in itiate
au to CPAP min 6 and max 20.
YES
NO
Is the patie nt in acu te
respiratory distress
NO
NO
Yes
No
Yes
No
Ye s
RT Sleep Disordered Breathing Algorithm
Nighttime CPAP/BiPAP
Revised 09-2017
*Positive pressur e is c ontr aindicate d in patients
with known CSF leak, recent transnasal or
esop hageal surge ry, and cran ial sku ll fractur es,
These patien ts ma y be monitored by oximetr y
and O2 will be titr ated to main tain SpO2 >9 2%
** Patie nts with recent spinal-lumbar trauma or
with orde rs to keep hea d of the bed flat will not
elevate HOB 30 degr ees
Last reviewed/revised: 09/2017
Contact CCKM for revisions.
COPD – Adult – Inpatient/
Ambulatory Guideline
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org