Optimizing Oral Medication Schedules for Inpatient Sleep: A Quality Improvement Intervention

Area of Science:

• Pediatric Hospital Medicine
• Quality Improvement Science
• Sleep Medicine

Background:

• Hospitalized children frequently experience sleep disturbances due to nighttime awakenings.
• Oral antibiotics are often administered around the clock, disrupting sleep despite comparable efficacy of daytime schedules.

Purpose of the Study:

• To evaluate the effectiveness of a quality improvement initiative designed to increase the use of sleep-friendly antibiotic administration schedules in hospitalized children.

Main Methods:

• Modified computerized provider order entry defaults for 4 oral antibiotics to favor waking-hour administration.
• Provided targeted education to care-team members on sleep-friendly scheduling.
• Monitored the proportion of sleep-friendly schedules and caregiver-reported sleep disruptions.

Main Results:

• Achieved a 72% increase in sleep-friendly antibiotic administration schedules.
• Care-team members showed increased agreement that around-the-clock medication causes sleep disruption post-education.
• Caregivers reported an increase in sleep disruption despite the increase in sleep-friendly orders.

Conclusions:

• Computerized provider order entry modifications and education are effective, low-cost strategies to promote sleep-friendly antibiotic scheduling.
• Patient perception of sleep disruption is multifactorial and may not directly correlate with objective scheduling changes.
• Increased focus on sleep during hospitalization can heighten awareness of sleep-disrupting factors.