Decrease in as-needed sedative use by limiting nighttime sleep disruptions from hospital staff.
J Hosp Med. 2009 Sep 18;
Authors: Bartick MC, Thai X, Schmidt T, Altaye A, Solet JM
BACKGROUND:: Hospital routines frequently interrupt nighttime sleep. Sedatives promote sleep, but increase the risk of delirium and falls. Few interventional trials have studied sleep promotion in medical-surgical units and little is known about its impact on sedative use. OBJECTIVE:: To determine causes of sleep disruption, and assess whether decreasing sleep disruptions lowers sedative use in medical-surgical patients. DESIGN AND SETTING:: Interventional trial with historical controls on a medical-surgical unit of a community teaching hospital. Nurses, physicians, and patients were blinded to the measurement of as-needed sedative use. PATIENTS:: Consecutive eligible adults (n = 161 preintervention patients, n = 106 intervention patients). INTERVENTION:: We developed the "Somerville Protocol," which included the establishment of an 8-hour "Quiet Time" that began with automated lights-off and lullaby; staff-monitored noise; and avoidance of waking of patients for routine vital signs and medications. MEASUREMENTS:: As-needed sedative use, responses to a patient questionnaire, and responses to a modified Verran Snyder-Halpern (VSH) sleep scale. RESULTS:: Preintervention, "hospital staff " was the disturbance most likely to keep patients awake. The intervention decreased the proportion of patients reporting it from 42% to 26%, a 38% reduction (P = 0.009; 95% confidence interval [CI]: 0.0452-0.2765). Preintervention, 32% of patients received as-needed sedatives, compared to 16% with the intervention, a 49% reduction (P = 0.0041; 95% CI: 0.056-0.26), with a 62% decrease in patients over age 64 years (P = 0.005). VSH scores were unchanged. CONCLUSIONS:: Small modifications in hospital routines, especially in the timing of vital signs and routine medication administration, can significantly reduce sedative use in unselected hospital patients. Journal of Hospital Medicine 2009. (c) 2009 Society of Hospital Medicine.
PMID: 19768797 [PubMed - as supplied by publisher]