Nocturnal care interactions with patients in critical care units

Sleep deprivation is common in critically ill patients and may have long-term effects on health outcomes and patients' morbidity. Clustering nocturnal care has been recommended to improve patients' sleep.

To (1) examine the frequency, pattern, and types of nocturnal care interactions with patients in 4 critical care units; (2) analyze the relationships among these interactions and patients' variables (age, sex, acuity) and site of admission to the intensive care unit; and (3) analyze the differences in patterns of nocturnal care activities among the 4 units.

A randomized retrospective review of the medical records of 50 patients was used to record care activities from 7 PM to 7 AM in 4 critical care units.

Data consisted of interactions during 147 nights. The mean number of care interactions per night was 42.6 (SD 11.3). Interactions were most frequent at midnight and least frequent at 3 AM. Only 9 uninterrupted periods of 2 to 3 hours were available for sleep (6% of 147 nights studied). Frequency of interactions correlated significantly with patients' acuity scores (r = 0.32, all Ps < .05). A sleep-promoting intervention was documented for only 1 of the 147 nights, and 62% of routine daily baths were provided between 9 PM and 6 AM.

The high frequency of nocturnal care interactions left patients few uninterrupted periods for sleep. Interventions to expand the period around 3 AM when interactions are least common could increase opportunities for sleep.