Creating Naptime: An Overnight, Nonpharmacologic Intensive Care Unit Sleep Promotion Protocol

Area of Science:

• Critical Care Medicine
• Sleep Science
• Healthcare Protocol Development

Background:

• Intensive care unit (ICU) patients experience significant sleep disruption, linked to increased mortality via ICU delirium.
• Experts recommend sleep promotion to prevent or shorten delirium duration.
• Existing ICU sleep promotion protocols are complex and challenging to implement.

Purpose of the Study:

• To describe the development, pilot implementation, and revision of a medical ICU sleep promotion protocol.
• To identify and address sources of overnight patient disturbance.
• To create a feasible and effective sleep promotion strategy for ICUs.

Main Methods:

• A literature review, medical chart review, and stakeholder interviews identified key sleep disruptors.
• An initial protocol, 'Naptime,' was developed with stakeholder input and piloted.
• Protocol monitoring and feedback informed revisions for unit-wide implementation.

Main Results:

• Major overnight disturbances included noise, patient care activities, and patient anxiety.
• The pilot protocol's focus on altering routine care timing faced frequent violations for lab draws and urgent needs.
• Stakeholder feedback led to protocol revision, emphasizing 60-120 minute rest periods with brief care clusters.

Conclusions:

• Achieving uninterrupted 4-hour rest blocks may be difficult for all ICU patients.
• Minimizing overnight interruptions is feasible and crucial for patient well-being.
• Successful adoption requires stakeholder involvement and continuous protocol reevaluation.