Improving Sleep Quality in the Adult Intensive Care Unit

Abstract

Problem: Intensive care unit patients are at increased risk for poor sleep quality due to high incidences of night time nursing interventions, leaving little time for restorative sleep. Poor sleep can arise from stress, pain, and misaligned circadian rhythms as well. Sleep deprivation is harmful and can cause cognitive, ventilatory, cardiovascular, hormonal, and immune problems. The prevalence of perceived poor sleep quality was determined in the adult intensive care unit over a 3-month period. Most patients (54%) rated their sleep quality as less than average. Purpose: The purpose of this quality improvement project is to improve sleep quality for stable adult intensive care unit patients by placing them on a multi-component sleep protocol that provides a 4-hour window of uninterrupted sleep. Methods: A multi-component sleep protocol was implemented over a 12-week timeframe which prioritized a disturbance free 4-hour sleep window between midnight and 4 a.m. Staff were educated through a poster board presentation and by email. Protocol components included offering sleep masks and ear plugs to the patient, hanging a sleep protocol sign on room doors, re-timing routine medication and blood draws, and nurses serving as gatekeepers to prevent in-room disturbances. Patient’s self-reported sleep quality was charted afterwards in the electronic medical record. Ancillary departments (phlebotomy, pharmacy, and respiratory care) were notified of the new practice change as well. Weekly run charts were used to analyze and track data on percent of staff educated, patient’s sleep quality, and nursing staff compliance rates. Results: Results show that 100% of night shift nurses were educated on the protocol, 84% of nurses documented patient’s stated sleep quality in the electronic health record, and of the 106 sleep observations performed, 70% were rated as good or excellent. Fifty-eight patients total were placed on the sleep protocol during the 12-week project. Conclusions: Sleep disturbances are multifactorial. A multi-component sleep protocol was shown to improve sleep quality for adult intensive care unit patients. Therefore, a sleep protocol that diminishes or eliminates preventable disturbances is beneficial to the overall health of critically ill patients and should be a part of standard practice.