Sleep-Promotion Bundle Development, Implementation, and Evaluation in Critically Ill Adults: Roles for Pharmacists

Area of Science:

• Critical Care Medicine
• Sleep Medicine
• Pharmacology

Background:

• Sleep disturbances are prevalent in intensive care units (ICUs), negatively impacting patient recovery.
• Implementing structured sleep improvement bundles is a growing area of focus in critical care.

Purpose of the Study:

• To review evidence on intensive care unit (ICU) sleep improvement bundle effectiveness.
• Identify optimal sleep bundle components and implementation strategies.
• Highlight the role of pharmacists in ICU sleep bundle initiatives.

Main Methods:

• Systematic review of multiple databases (1990-2021) using keywords: sleep, intensive care, critical care, protocol, bundle.
• Screening, data extraction, and risk-of-bias assessment of identified studies.
• Review of ICU quality improvement literature and Institute for Healthcare Improvement guidance.

Main Results:

• Nine studies (3 randomized, 1 quasi-experimental, 5 before-and-after) met inclusion criteria.
• Bundles primarily used nonpharmacological interventions; few included medication strategies.
• Associated outcomes included reduced delirium (5 studies), improved total sleep time (2 studies), and improved patient-perceived sleep (2 studies).
• Pharmacists were involved in 4 studies.

Conclusions:

• Sleep improvement bundles are recommended for all critically ill adults.
• Individualize bundle components and team roles at the institutional/ICU level.
• Pharmacists can lead the development and implementation of ICU sleep bundles.