The Implementation of Nocturnal Earplugs and Eye Masks to Improve Sleep in the Cardiac Surgery Intensive Care Unit

Abstract

Background: Sleep deprivation is a major concern among intensive care unit patients, with more than 60% recounting poor sleep, often lasting six to twelve months after discharge. Consequences of poor sleep include disruptions in immunity and endocrine function, impaired cognitive function, and increased length of stay and mortality. Excess noise and light frequently contribute to sleep and circadian disturbances in the intensive care unit. The use of nocturnal earplugs and eye masks is suggested to increase sleep quality among patients in the intensive care setting. Local Problem: Sleep disturbance was identified as a problem in the Cardiac Surgery Intensive Care Unit at a large, academic hospital in Maryland. The purpose of this project was to implement and evaluate the usability and feasibility of nocturnal earplugs and eye masks in the Cardiac Surgery Intensive Care Unit at this institution. Interventions: The Plan-Do-Study-Act Cycle was used to provide an organizing structure for the implementation of this 11-week, quality improvement project. Extubated, oriented, nonsedated Cardiac Surgery Intensive Care Unit patients were asked to wear earplugs and eye masks from 2200 to 0400. At 0600, patients completed a Patient Usability Survey evaluating the amount and quality of sleep, and the comfort of the earplugs and eye masks. The bedside nurse simultaneously completed a Nursing Questionnaire evaluating which intervention(s) was worn and duration of wear, if they believed the sleep aids helped their patient sleep through nursing interventions, and if they would recommend earplugs and eye masks to a future patient. Surveys were completed the first night after earplug and eye masks use. Results: 63 surveys were completed and returned, of which 51% (32 patients) refused to use the earplugs and eye masks. Of the 31 patients who participated, 68% (n=21) reported at least four hours of sleep, and 42% (n=13) rated their sleep quality as “More than average/normal” or “Much more than average/normal.” 45% (n=14) of patients rated the earplugs as “Comfortable” or “Very comfortable,” and 61% (n=19) rated the eye mask as “Comfortable” or “Very comfortable.” 45% (n=14) of participating patients wore both the earplugs and eye mask for the majority of the time between 2200 and 0400, with 68% (n=21) wearing them for at least four hours. 81% (n=25) of nurses “Agreed” or “Strongly Agreed” that the sleep aids helped their patient sleep through nursing interventions, and 90% (n=28) “Agreed” or “Strongly Agreed” to recommend their use to a future Cardiac Surgery Intensive Care Unit patient. Conclusions: Most patients who accepted the earplugs and eye masks found them comfortable and beneficial. Nurses believed they helped patients sleep through interventions and recommended their use. Despite positive outcomes in those who participated, a high refusal rate suggests the use of earplugs and eye masks may not be well suited for the Cardiac Surgery Intensive Care Unit patient population. Sleep aids should continue to be offered due to the benefits noted in those who utilized them and be encouraged for use in other units in the hospital with a broader inclusion and exclusion criteria.