Intensive Care Unit Sleep Promotion Bundle: Impact on Sleep Quality, Delirium, and Other Patient Outcomes

Abstract

Background High-quality sleep is important for optimal patient recovery. Sleep deprivation during hospitalization may lead to poor patient outcomes. Objective To examine whether implementation of a sleep promotion bundle in the intensive care unit affects rates of delirium and agitation, restraint use, and length of stay. Methods An evidence-based sleep promotion bundle was developed and implemented in 2 intensive care units in a 1025-bed level I trauma teaching hospital. Deidentified data from the electronic health record were obtained for patients hospitalized before and during the intervention. Data included scores on the Confusion Assessment Method for the Intensive Care Unit, Richmond Agitation-Sedation Scale, and Glasgow Coma Scale; restraint use; and hospital and intensive care unit length of stay. Results A total of 137 patients during the preintervention period and 149 patients during the intervention period were hospitalized in the intensive care units and met inclusion criteria. A 9-percentage-point decrease in the incidence of delirium from before to during the intervention was found, although it was not statistically significant (P = .07). Significant reductions were found in both intensive care unit (P = .04) and hospital (P = .03) length of stay. A significant decrease was found in Richmond Agitation-Sedation Scale high scores for patients requiring mechanical ventilation (P = .03). No significant differences were found in Richmond Agitation-Sedation Scale low scores, Glasgow Coma Scale scores, or restraint use. Conclusions Critical care nurses are in an optimal position to implement evidence-based sleep promotion measures. Further research on sleep promotion bundles is needed.