Background: Sleep disturbance has negative impact on physical coordination, metabolism, cognitive performance, immune function, coagulation cascade, cardiac risk and is associated with an increased risk of falls in hospitalized patients. The number of adverse events related to falls is startling and it poses a major health risk for patients in acute care facilities. As the aging population grows, there is mounting emphasis on delivery of quality care, patient safety and satisfaction in our hospitals.
Purpose: We aimed to enhance patient safety by improving quality of sleep and thereby decreasing the number of falls related to sleep disturbance.
Description: We initiated a sleep study pilot with a multidisciplinary approach to improve the environmental, medical, and pharmacological aspects of patient care in one of our 40-bedded inpatient medicine units. Patients who met criteria for risk of falls/falls with harm based on the hospital protocol were included in the pilot. Patients needed to be alert and fully oriented with willingness to participate in the study. Our interventions included providing patients with sleep bundle consisting of eye mask, ear plugs, and headphones. We implemented nightly tuck-in rounds and quiet time hours. Medications were rescheduled by the unit pharmacist to minimize sleep disturbance during the night. We limited blood draws and vital sign checks overnight. Melatonin was used in lieu of zolpidem for sleep aid if needed. Using the Likert scale with 0 being complete sleeplessness and 10 being excellent sleep, the patient’s quality of sleep was assessed by the nursing staff on a daily basis and an exit survey was completed by the patient on the day of discharge. We also conducted an anonymous survey among the nursing and patient care assistant staff to gauge their engagement and experience. Lastly, we tracked the number of falls in the pilot group.
Conclusions: The average age of the 102 patients enrolled from May to September 2018 was 68.5 years old. The average score based on the patient’s subjective rating on the quality of sleep was 6.3, 6.6, 6.4, and 6.5 for days 1 through 4, respectively. The patient’s own estimated number of hours slept per night was 5.5, 5.8, 5.4, and 5.4 for days 1 through 4, respectively. There was a total of 35 medication related interventions, most common one being the adjustment of the medication administration time. The average score for the overall sleep quality was 6.9 based on the exit survey and there were no falls in the pilot group. Although we demonstrated no significant improvement in the patient’s perceived quality of sleep despite our various interventions, the fact that there were no falls in our fall risk group is a gratifying outcome. Furthermore, our staff survey results showed that 90% believed the sleep study pilot improved quality of care for their patients and 76% found this process to be effective. Staff engagement will continue to be important in ensuring sustainability and success of our quality improvement project.