| Description |
Abstract Background: Poor sleep is common in ICU and acute ward settings due to noise and other factors, negatively impacting patients' cognitive function and quality of life. Neglecting healthy sleep practices in hospitals can have adverse implications for patient outcomes because of the restorative nature of sleep. Local problem: Hospitalized patients often experience poor sleep quality due to various factors, such as noise disturbances and staff interruptions. Poor sleep quality can lead to adverse effects such as delirium, immune function impairment, and depression. Therefore, non-pharmaceutical interventions are necessary to promote healthy sleep and optimize healing environments in acute medicine units. Methods: The project was implemented at the Veteran Affairs Medical Center in Salt Lake City, Utah, on a 20-bed acute medicine unit (AMU). This quality improvement (QI) project involved four phases: 1) assessment of patients' sleep quality using the Pittsburgh Sleep Quality Index (PSQI), 2) documenting of patients' room entries between 2200-0500, 3) nursing staff presentation with a pre/post survey, and 4) development and implementation of a sleep hygiene bundle. The sleep hygiene bundle was developed using evidence-based research and nursing staff feedback. In addition, this QI project's feasibility, usability, and satisfaction were addressed using nursing staff surveys. Intervention: The sleep hygiene bundle interventions included administering medications prior to 2200, limiting room entries during 2200-0500, offering TV/lights off, offering eye masks/ear plugs, closing patient's room doors, checking alarms, hallway lights dimmed, and minimizing noise in hallways/nurses' station. This QI project aimed to improve the sleep quality of patients admitted to the AMU by using a sleep hygiene bundle with non-pharmaceutical interventions performed by nursing staff. Results: 41 patients participated in the PSQI survey, 13 pre-implementation, and 28 post-implementation. The patients surveyed were veterans, predominantly male (n=34, 82.9%), and Caucasian (n=36, 87.3%). A statistically significant change is evident in the global PSQI score (p=0.0001) from pre- to post- implementation. No statistically significant change was shown from pre- to post-implementation in the 3 seven components of the PSQI. The mean number of patient room entries during pre-implementation was 22.10 (SD=21.53), and post-implementation was 4.39 (SD=5.50) (p=0.001). Overall, nursing staff compliance with the implementation of the sleep hygiene bundle was 50%. Conclusion: Implementing a sleep hygiene bundle in AMU revealed statistically significant improvements in the PSQI global score. However, this study did not show statistically significant improvements in the PSQI seven components. The findings of this QI project do not align with those in previous studies where an overall improvement in patients' sleep quality was witnessed with the introduction of a sleep hygiene bundle. |
