Improving BiPAP/CPAP Compliance

Positive airway pressure has proven to be an effective therapy for obstructive sleep apnea (OSA) and non-invasive ventilation (NIV) for COPD diagnoses. However, it is estimated that only 30% to 40% of individuals recommended for therapy are 100% compliant. With the right program, the sub-acute setting has the resources to improve patient compliance and enhance outcomes. 

Respiratory Therapy Assessments & Follow-ups

NJRA's clinical offering provides skilled nursing facilities with respiratory therapists and 24/7 respiratory support. OSA and NIV residents requiring a CPAP, BiPAP, AutoPAP, BiPAP ST, or Trilogy will receive an assessment by NJRA’s respiratory therapist within 24 hours of admission. 

Residents are assessed on a case-by-case basis. The most common order is for the respiratory therapist to follow-up weekly for six weeks. After six weeks, visits may be scaled back depending on the resident’s status and compliance level. 

Residents who are determined to be non-compliant by nursing and the therapist will receive compliance-building exercises outlined in NJRA’s BiPAP & CPAP Compliance Program for 21 days. After 21 days, residents who are 100% non-compliant will receive a recommendation to discontinue their ‘PAP device. The recommendation will be passed along to the physician for consideration. In some cases, physicians prefer to not discontinue the ‘PAP device. In those cases, NJRA will scale back visits and continue compliance-building exercises upon each visit.   

NJRA BIPAP & CPAP Compliance Program

1. Pressure and Mask Modifications: Our goal is to take 21-days is to establish and increase BiPAP or CPAP compliance. This first step is for nursing and the respiratory therapist to recommend any order changes that may increase comfort measures. This includes adjusting pressures, sampling & fitting masks, and adding humidity. Recommendations are then submitted to the physician for order approval.

2. Time-building Trials: To build compliance, nursing will trial the machine during the day. They will start by spending 15-30 minutes with the resident using the machines for intervals of 1-5 minutes, adding a minute or two each day with the goal of reaching 30-45 minute intervals. Once the resident can tolerate for longer-periods during the day, nursing can start doing daily trials at night before sleep. The goal is for the resident to eventually fall asleep during a nightly trial. Nursing can document the trials on the chart below.

3. Outcomes: Nursing will document the outcomes of each program. NJRA will help each facility track their outcomes and measure the effectiveness. Residents who are 100% non-compliant after the program will receive a recommendation to discontinue their ‘PAP device. The recommendation will be passed along to the physician for consideration.