Knauert MP, Redeker NS, Yaggi HK, Bennick M, Pisani MA. Creating Naptime: An Overnight, Nonpharmacologic Intensive Care Unit Sleep Promotion Protocol.
J Patient Exp 2018;
5:180-187. [PMID:
30214923 PMCID:
PMC6134539 DOI:
10.1177/2374373517747242]
[Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Introduction:
Patients in the intensive care unit (ICU) have significantly disrupted sleep. Sleep
disruption is believed to contribute to ICU delirium, and ICU delirium is associated
with increased mortality. Experts recommend sleep promotion as a means of preventing or
shortening the duration of delirium. ICU Sleep promotion protocols are highly complex
and difficult to implement. Our objective is to describe the development, pilot
implementation, and revision of a medical ICU sleep promotion protocol.
Methods:
Naptime is a clustered-care intervention that provides a rest period
between 00:00 and 04:00. We used literature review, medical chart review, and
stakeholder interviews to identify sources of overnight patient disturbance. With
stakeholder input, we developed an initial protocol that we piloted on a small scale.
Then, using protocol monitoring and stakeholder feedback, we revised
Naptime and adapted it for unitwide implementation.
Results:
We identified sound, patient care, and patient anxiety as important sources of
overnight disturbance. The pilot protocol altered the timing of routine care with a
focus on medications and laboratory draws. During the pilot, there were frequent
protocol violations for laboratory draws and for urgent care. Stakeholder feedback
supported revision of the protocol with a focus on providing 60- to 120-minute rest
periods interrupted by brief clusters of care between 00:00 and 04:00.
Discussion:
Four-hour blocks of rest may not be possible for all medical ICU patients, but
interruptions can be minimized to a significant degree. Involvement of all stakeholders
and frequent protocol reevaluation are needed for successful adoption of an overnight
rest period.
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