Intervention significantly improves daily noise rating, decreases incidence of delirium/coma
TUESDAY, March 5 (HealthDay News) -- Simple interventions to promote sleep are feasible for patients in medical intensive care units (ICUs) and result in improvements in nighttime noise and reduced incidence of delirium/coma, according to a study published in the March issue of Critical Care Medicine.
Biren B. Kamdar, M.D., M.B.A., M.H.S., of Johns Hopkins University in Baltimore, and colleagues conducted an observational study involving 300 patients with more than one night in the ICU to determine whether a quality improvement intervention, involving multifaceted sleep-promoting steps that were implemented with the aid of daily reminder checklists for ICU staff, could improve patients' sleep and reduce delirium/cognition issues. Interventions included nighttime environmental steps such as turning off televisions and dimming lights; daytime interventions such as preventing excessive napping and raising window blinds; and nonpharmacologic sleep aids such as eye masks, ear plugs, and tranquil music.
The researchers found that checklist item completion varied from 86 to 94 percent over the 826 patient-day quality improvement period. In multivariate analyses, there was an improvement in overall Richards-Campbell Sleep Questionnaire sleep quality ratings in the quality improvement versus baseline stages, but this did not reach statistical significance. Significant improvements were observed in daily noise ratings; incidence of delirium/coma (odds ratio, 0.46); and daily delirium/coma-free status (odds ratio, 1.64).
"Using a structured process, we implemented a multifaceted, multistage quality improvement intervention to promote sleep, demonstrating that such efforts were feasible as part of routine ICU care and were associated with significant reductions in perceived nighttime noise levels and a substantial decrease in delirium/coma," the authors write.
Abstract (http://journals.lww.com/ccmjournal/Abstract/2013/03000/The_Effect_of_a_Quality_Improvement_Intervention.12.aspx )Full Text (subscription or payment may be required) (http://journals.lww.com/ccmjournal/Abstract/2013/03000/The_Effect_of_a_Quality_Improvement_Intervention.12.aspx )