Decrease in as-needed sedative use by limiting nighttime sleep disruptions from hospital staff.

Abstract

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.