Improving Sleep Quality on the First Postoperative Night in the Intensive Care Unit: A Quality Improvement Initiative

Area of Science:

• Critical Care Medicine
• Sleep Science
• Quality Improvement

Background:

• Sleep disruption is prevalent in critically ill patients, linked to delirium, immune dysfunction, and poor quality of life.
• The initial postoperative night in the intensive care unit (ICU) presents unique sleep challenges due to pain, anxiety, and frequent care.
• Existing interventions have not reliably improved sleep for this vulnerable patient population.

Purpose of the Study:

• To evaluate the effectiveness of a multimodal, low-cost sleep bundle in improving patient-reported sleep quality in the ICU.
• To assess the impact of interventions on nurse-perceived sleep quality, sleep quantity, and patient satisfaction.
• To monitor nurse workload and adverse events as balancing measures.

Main Methods:

• A quality improvement project utilized six Plan-Do-Study-Act cycles over seven months.
• Postoperative adult ICU patients meeting specific eligibility criteria were included.
• Interventions comprised staff engagement, sensory aids (earplugs/eye masks), environmental modifications (door closure), pain management review, noise monitoring, simplified surveillance, and melatonin administration.

Main Results:

• Patient-reported sleep quality showed a modest increase from 5.0 to 5.4/10.
• Nurse-perceived sleep quality demonstrated favorable variation following streamlined surveillance protocols.
• No significant increase in nurse workload or adverse events was observed.

Conclusions:

• A multimodal, low-cost sleep bundle offers a modest improvement in sleep quality for ICU patients.
• The intervention was implemented without augmenting staff burden, suggesting feasibility for widespread adoption.
• Continuous data analysis facilitated real-time adaptation, highlighting its value for similar quality improvement initiatives.