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

Update item information
Identifier 2018_Dalton
Title A Sleep/Wake Protocol to Reduce Delirium in the CVICU and SICU
Creator Dalton, Anna T.
Subject Advanced Practice Nursing; Education, Nursing, Graduate; Systems Analysis; Delirium; Intensive Care Units; Sleep Wake Disorders; Clinical Protocols; Quality of Life; Quality of Sleep
Description 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.
Relation is Part of Graduate Nursing Project, Doctor of Nursing Practice
Publisher Spencer S. Eccles Health Sciences Library, University of Utah
Date 2018
Type Text
Rights Management © 2018 College of Nursing, University of Utah
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah
Collection Nursing Practice Project
Language eng
ARK ark:/87278/s6rv4vfn
Metadata Cataloger AMT
Setname ehsl_gradnu
Date Created 2018-08-27
Date Modified 2019-02-05
ID 1366604
Reference URL https://collections.lib.utah.edu/ark:/87278/s6rv4vfn