Implementation of a Non-pharmacologic Sleep Promotion Protocol on the Intensive Care Unit

Abstract

Problem & Purpose: Complex care requirements on medical intensive care units (MICU) cause patient’s sleep to be deprioritized. Critical care patients who encounter sleep disturbances are at an elevated risk for delayed healing, prolonged stays, elevated cost of care, and mortality. The MICU at a large academic center uses sleep promotion tactics on less than 10% of their patients despite evidence demonstrating the benefits of non-pharmacologic sleep promotion protocols. The purpose of this quality improvement project is to implement a sleep promotion protocol on the MICU to enhance patient sleep quantity and quality through non-pharmacologic interventions. Methods: Sleep promotion protocol education occurred for one week. Sleep promotion was added to a MICU rounding checklist and a sleep promotion protocol algorithm was created and displayed in each patient room. Data was collected using chart audits and surveys to assess if the sleep promotion protocol was ordered appropriately, if sleep promotion was discussed during rounds, and how many hours a patient slept. Run charts were used to analyze variations, central tendencies, runs, and trends in the data collected and to determine if a sleep promotion protocol increases patients sleep. Results: Prior to project implementation 0% of patients had sleep discussed during rounds, 0% of patients had sleep promotion ordered, and patients slept an average of 3 hours per night. Results from post implementation data suggest 90% of patients have sleep promotion discussion during rounds, 90% of patients have the sleep promotion protocol ordered appropriately, and patients using the sleep promotion protocol sleep on average 5.5 hours per night. Conclusions: Findings suggest that the implementation of a sleep promotion protocol on the MICU increases communication about patient’s sleep and increases the quantity of patient’s sleep. Discussing sleep during dayshift rounds increases the likelihood of sleep promotion interventions during night-shift sleep time.