1 2 3 Corresponding author's email: geeta.mehta@utoronto.ca Rationale Patients in the intensive care unit (ICU) experience qualitative and quantitative sleep disruption. The consquences are sleep deprivation, and possibly adverse physiological and psychological sequelae. Patient-related factors (eg. illness, pain), environmental factors (eg. light, noise), and health support techniques (eg. mechanical ventilation, sedation) all contribute to sleep disruption. The current study reports patients' perspectives regarding sleep in the ICU. Methods Since June 2009, all patients admitted to the Mount Sinai Hospital Medical/Surgical ICU for ≥ 1 night were approached within 72 hours of discharge.Patients were asked to complete a sleep questionnaire if they passed an assessment of orientation and if they were able to communicate. The questionnaire explored the patients' quality and quantity of sleep in the ICU and following discharge from the ICU, ICU-related factors contributing to poor sleep, and possible changes in the ICU that could improve patients' sleep. Patient demographics (age, gender) as well as admission data (mechanical ventilation, sedation, APACHE II scores) were collected from patients' charts. ResultsThe target N is 100. In the first 48 patients (25 M:23 F), mean age ± SD was 56 ± 19 years (range 20-94), and mean APACHE II score was 18 ± 8. Of the sample, 33% were mechanically ventilated, and 62% received intravenous (IV) sedatives (intermittent or continuous). The average ICU length of stay was 4 nights. Sleep quality in the ICU was rated as poor or very poor by 69% of patients; and sleep quantity rated as poor or very poor by 58%. The 5 most frequently cited reasons for poor sleep were: noise (40%), pain (40%), presence of IV lines (35%), time disorientation (35%), and discomfort (30%). Patients most commonly identified the following as potentially improving sleep in the ICU: closing doors/blinds at night (42%), no unnecessary interruptions (40%), sleeping pills (33%), and dimmed lights (27%). Following ICU discharge, in-hospital sleep quality improved, primarily due to a reduction in pain (43%), fewer nocturnal interruptions (40%), and less noise (30%). Patients who received IV sedatives reported better quality of sleep (p<0.01). No significant correlations were found between perceived sleep quality and illness severity or intubation/mechanical ventilation. ConclusionsThe majority of ICU patients experience poor sleep in the ICU, regardless of whether they are intubated/mechanically ventilated. Patient-identified environmental factors to improve night-time sleep were considerable and modifiable, indicating the possibility for further development of clinical protocols. This abstract is funded by: Ontario Thoracic SocietyAm J Respir Crit Care Med
BackgroundBenzodiazepines and sedative hypnotics (BSH) have numerous adverse effects that can lead to negative outcomes, particularly in vulnerable hospitalised older adults. At our institution, over 15% of hospitalised older adults are prescribed sedative-hypnotics inappropriately. Of these prescriptions, 87% occurred at night to treat insomnia and almost 20% came from standard admission order sets.MethodsWe conducted a time-series study from January 2015 to August 2016 among medical and cardiology inpatients following the implementation in August 2015 of a sedative reduction bundle (education, removal of BSH from available admission order sets and non-pharmacological strategies to improve sleep). Preintervention period was January–July 2015 and postintervention period was August 2015–August 2016. A surgical ward served as control. Primary outcome was the proportion of BSH-naive (not on BSH prior to admission) patients 65 years or older discharged from medical and cardiology wards who were prescribed any new BSH for sleep in hospital. Data were analysed on statistical process control (SPC) p-charts with upper and lower limits set at 3δ using standard rules. Secondary measures included Patient-reported Median Sleep Quality scores and rates of fall and sedating drug prescriptions that may be used for sleep (dimenhydrinate).ResultsDuring the study period, there were 5805 and 1115 discharges from the intervention and control units, respectively. From the mean baseline BSH prescription rate of 15.8%, the postintervention period saw an absolute reduction of 8.0% (95% CI 5.6% to 10.3%; p<0.001). Adjusted for temporal trends, the intervention produced a 5.3% absolute reduction in the proportion of patients newly prescribed BSH (95% CI 5.6% to 10.3%; p=0.002). BSH prescription rates remained stable on the control ward. Patient-reported measure of sleep quality, falls and use of other sedating medications remained unchanged throughout the study duration.ConclusionA comprehensive intervention bundle was associated with a reduction in inappropriate BSH prescriptions among older inpatients.
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