“Help Me Sleep”: A Quality Initiative to Reduce Overnight Vital Signs

Abstract

BACKGROUND AND OBJECTIVES Sleep is an essential part of the recovery process, yet inpatient sleep quality is poor. Patients and families report that vital signs are the most bothersome overnight disruption. Obtaining vital signs every 4 hours (Q4H) is not evidence-based and is frequently ordered indiscriminately. We aimed to decrease the percentage of patient nights with vital sign checks between 12 am and 6 am in a low-risk population from 98% to 70% within 12 months to minimize overnight sleep disruptions and improve inpatient sleep. METHODS We conducted a quality improvement project on 3 pediatric hospital medicine teams at a large free-standing children’s hospital. Our multidisciplinary team defined low-risk patients as those admitted for hyperbilirubinemia and failure to thrive. Interventions were focused around education, electronic health record decision support, and patient safety. The outcome measure was the percentage of patient nights without a vital sign measurement between 12 am and 6 am and was analyzed by using statistical process control charts. Our process measure was the use of an appropriate vital sign order. Balancing measures included adverse patient events, specifically code blues outside the ICU and emergent transfers. RESULTS From March 2020 to April 2021, our pediatric hospital medicine (PHM) services admitted 449 low-risk patients for a total of 1550 inpatient nights. The percentage of patient nights with overnight vital signs decreased from 98% to 38%. There were no code blues or emergent transfers. CONCLUSION Our improvement interventions reduced the frequency of overnight vital sign monitoring in 2 low-risk groups without any adverse events.

Promoting a Sleep-friendly Environment by Minimizing Overnight Room Entries

“…Others have conducted QI interventions intending to minimize unnecessary disruptions to sleep. 7,10,[13][14][15] Cooke et al, 7 Lee et al, 13 and Lin et al 14 similarly targeted overnight vital sign orders; however, Cooke et al only targeted blood pressure, while Lee et al targeted blood pressure and temperature measurement (in addition to laboratory collection timing). Lin et al limited the study population to pediatric patients hospitalized with failure to thrive or hyperbilirubinemia.…”

A nursing perspective on inpatient sleep and circadian disruptions for pediatric stem cell transplant patients

“…24 Promising quality improvement work in a children's hospital showed that overnight vital signs could be safely decreased by 60% in a low-risk patient population without any adverse events. 25 A second major challenge described by participants related to the limitations of the hospital room. Although nurses were quick to acknowledge that no patient expects their hospital room to resemble a "Hilton hotel," they pointed to poor soundproofing in all rooms, and insufficient or excess light exposure depending on the room.…”

“…Among adult SCT patients, data have suggested that less rigorous monitoring of vital signs for lower‐risk patients may be safe and simultaneously allow for more uninterrupted time for those recovering after SCT 24 . Promising quality improvement work in a children's hospital showed that overnight vital signs could be safely decreased by 60% in a low‐risk patient population without any adverse events 25 …”

Quasi-experimental, Nonrandomized Initiative to Minimize Sleep Disruptions among Hospitalized Children

“…Nonetheless, the positive results seen in this and similar studies at other sites suggest this approach may be applicable across pediatric health systems. 6,[11][12][13]…”