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Protecting Sleep Hygiene in the PICU: A Quality Improvement Project
Nathan P Dean1, Sopnil Bhattarai2, Sara Rooney3
1Division of Critical Care Medicine, Johns Hopkins All Children's Hospital, St Petersburg, FL.
Insights
Implementing a sleep hygiene team and adjusting routine tasks significantly improved sleep for pediatric intensive care unit (PICU) patients. This initiative reduced sleep interruptions, enhancing patient recovery.
Area of Science:
- Pediatric critical care medicine
- Quality improvement science
- Sleep medicine
Background:
- Sleep disturbances are common in pediatric intensive care units (PICUs), negatively impacting patient recovery.
- Routine medical tasks often interrupt critically ill children's sleep, hindering healing processes.
Purpose of the Study:
- To enhance the duration of uninterrupted sleep for patients in the PICU.
- To implement strategies that minimize sleep disruptions caused by routine care activities.
Main Methods:
- A multidisciplinary sleep hygiene team was formed to improve sleep protocols in the PICU.
- Nursing policies were revised to limit routine tasks between 11 PM and 5 AM.
- Interventions included staff education, daily goal sheet discussions, and a dedicated sleep hygiene order set.
Main Results:
- Baseline data showed only 32% of eligible patients experienced uninterrupted sleep.
- Initial interventions increased uninterrupted sleep to 58%, with a subsequent decrease to 33% after adding pupillary checks.
- Post-intervention, with enhanced protocols, 49% of patients achieved uninterrupted sleep.
Conclusions:
- A dedicated sleep hygiene team and revised care schedules effectively improved protected sleep for PICU patients.
- Multifaceted interventions, including policy changes and daily rounds integration, are key to successful sleep hygiene improvement.
- Continuous monitoring and adaptation of strategies are crucial for sustained positive outcomes in pediatric critical care sleep quality.
Objectives:
To increase the number of nights without sleep interruptions for routine tasks in recovering PICU patients.
Design:
Prospective quality improvement project.
Setting:
Single-center, free-standing, tertiary children's hospital.
Patients:
Patients admitted to the PICU for greater than 72 hours and eligible for early mobilization.
Interventions:
A multidisciplinary sleep hygiene team was created to improve sleep hygiene in critically ill patients eligible for early mobilization. This team rewrote local nursing policies to avoid routine tasks between 11 pm and 5 am . The team provided periodic control chart updates to staff detailing progress made protecting sleep. Discussions of sleep hygiene were added to the daily goal sheet and a sleep hygiene order set was created. Finally, the PICU quality dashboard was modified to show whether a sleep hygiene order set was initiated in eligible patients.
Measurements And Main Results:
Routine tasks were defined as daily chest radiographs, baths, routine tracheostomy care, central line dressing changes, twice daily medications, weights, and Foley care. After a year of data collection, avoidance of routine pupillary examinations was added to the sleep protection criteria. Baseline data was collected for 2 months prior to the creation of the sleep hygiene team. Screening of eligible patients occurred 1 week each month. The data were analyzed utilizing control charts. Baseline data demonstrated 32% of PICU patients without sleep interruptions. The centerline increased to 58% after the initial interventions but dropped to 33% after inclusion of pupillary checks. Following the introduction of the daily goal sheet, sleep hygiene order set, and tracking on the quality board, 49% of patients went without interruptions.
Conclusions:
The initiation of a sleep hygiene team along with retiming routine tasks, daily discussions on rounds with the daily goal sheet, introduction of a sleep hygiene order set, and transparent tracking improved the percentage of patients with protected sleep.
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