The effect of a non-pharmacologic sleep bundle on the incidence of delirium

Abstract

Background: Delirium is a multifactorial psychiatric syndrome commonly seen in the intensive care unit (ICU) setting due to serotonergic drug use, anesthesia use, high ambient light and noise, and continual sleep disruptions. Delirium increases length of hospital stay (LOS), length of time on mechanical ventilation (MV), post-discharge impairment, mortality, and health care costs. A random daily audit was performed in the Surgical Cardiovascular ICU (SCVICU) of a large urban hospital and showed a 36% incidence of delirium in the cardiac surgery patient population, and a follow-up survey showed an 11% incidence. Purpose: The purpose of this quality improvement project was to implement a non-pharmacological sleep promotion bundle (SPB) to evaluate its effectiveness in reducing the incidence of delirium among adult cardiac surgery patients in a SCVICU. Intervention: A checklist of evidenced-based sleep interventions was created for nightly use by nursing staff. The checklist included offering patients eye masks and near plugs, clustering nursing tasks, and environmental light and noise reduction measures. Methods: Delirium was measured through use of the Confusion Assessment Method for the ICU(CAM-ICU) score as documented by nursing. Use of the SPB was documented by nursing staff in the electronic medical record. Results: Results showed that the rates of delirium in the SCVICU improved from an 11% incidence of delirium during the pre-implementation phase to 6% incidence post-implementation. Conclusions: Findings support that the use of a non-pharmacological SPB decreases the incidence of delirium in cardiac surgery patients in the SCVICU. Implications for Practice: The SPB is a feasible, cost effective, and manpower-efficient solution for potentially reducing delirium in cardiac surgery patients during their stay in the ICU, indirectly improving patient outcomes such as mortality, LOS, time on MV, post-discharge functional ability, and healthcare costs.