A Sleep/Wake Protocol to Reduce Delirium in the CVICU and SICU

Background: Critically ill and hemodynamically unstable patients are at risk for experiencing a decrease in quality and quantity of sleep. Sleep deprivation in critically ill patients has been associated with an increased incidence of ICU delirium. Purpose: To decrease the incidence of delirium and improve perceived patient sleep quality through optimization of environmental factors (noise, light, nursing activities) as well as non-environmental factors (pain, mechanical support devices, procedures) in a Cardiovascular and Surgical ICU. Methods: This QI project was implemented at a large academic facility in the intermountain west within two intensive care units (N = 596). The SICU is a 12-bed unit and the CVICU is a 20-bed unit comprised of adult post-operative, trauma, and critically ill patients. Using a pretest-posttest study design, baseline data was collected prior to implementation of the Sleep/Wake protocol after which post-implementation data was collected. The Sleep/Wake protocol is comprised of environmental interventions to complete during day and night shift. Measures: Primary outcome of delirium was measured using the confusion assessment method-ICU. Secondary outcome of perceived sleep included a baseline sleep survey of sleep quality prior to hospitalization plus the Richards-Campbell Sleep Questionnaire. Nurse surveys were used to evaluate usability and satisfaction of the protocol. Results: During the pre- and post-intervention there were 272 and 229 patients respectively who were screened for delirium and who participated in the RCSQ. Incidence of delirium decreased from 82/272 (30%) pre- vs 55/229 (24%) (p-value 0.13) post-intervention. Compliance with the Sleep/Protocol ranged from 20-98%, respectively. Perceived sleep quality showed similar mean (SD) between both groups with the greatest difference made in noise level (before 65(22), after 68(20), p=0.16). Satisfaction of the protocol was evaluated via nurse survey. Overall, 88% of those surveyed were satisfied with the protocol. Conclusions: The implementation of a Sleep/Wake Protocol is feasible within a surgical and cardiovascular ICU and showed a decrease in incidence of delirium pre- to post-intervention, but was not statistically different. There was neither improved nor reduced patient sleep quality, however staff were overall satisfied with the protocol.