Doctor of Nursing Practice (DNP) Projects


Simplified Airway Risk Index and The Electronic Health Record

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Post-BSN for Nurse Anesthetists (DNP-NA)


Difficult airway management, cannot intubate



Background and Relevance: Despite advanced airway management practices, unanticipated airway complications remain. Intubation failures are estimated at 0.1%, and difficult tracheal intubation at 7.4%.1 Critical care nurses, intensivists and anesthesia providers must be aware of potential factors for high risk for airway management.

Local Problem and Purpose/Objectives: Intubation complications may cause comorbidities and death.1 A quality improvement (QI) project examined discrepancies between a standardized checklist, the Simplified Airway Risk Index (SARI), and electronic health record (EHR) documentation.

Methods: This descriptive QI project conforming to SQUIRE 2.0 Guidelines was conducted in an academic medical center and involved a systematic evaluation of airway management risk in 120 critically ill patients. SARI scoring criteria (high-risk score ≥ 4) was obtained from EHR information and patient assessments performed by specially trained critical care nurses.

Interventions: A DNP Nurse Anesthesia student collected and validated all findings. After determining a SARI risk score, a review of EHR documentation was conducted to support SARI scores. Data was analyzed using descriptive statistics, intraclass correlation coefficient (ICC), and linear regression analysis.

Results: The SARI classified 23.3% (n = 28) of patients as high risk for difficult airway management, but only 2.5% (n = 3) of patients were identified in the EHR (ICC = .006, P = .448 indicating poor reliability between data sources). Neither age, gender or body mass index predicted SARI scores (P = .935).

Conclusions: The discrepancy between the SARI scoring and EHR documentation supports the need for standardized methods to identify airway management risks.

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Date Posted: 25 February 2022