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Our August 6, 2013 Patient Safety Tip of the Week “Let Me Sleep!” highlighted the problem of sleep deprivation amongst hospitalized inpatients. Interference with sleep is also a contributing factor to other problems, such as delirium. For years we’ve espoused the “Say no to sleep meds” approach to hospitalized patients. That means identifying the numerous things we do that prevent patients from getting needed sleep and using nonpharmacological approaches to improve their sleep while hospitalized.
Herscher et al. (Herscher 2021) recently reported on successful implementation of a nonpharmacologic sleep hygiene intervention to improve sleep quality in hospitalized patients. The intervention consisted of a bundle with the following components:
Their program also included provider education and use of front-line “champions”.
Patients’ sleep was measured by the Richards-Campbell Sleep Questionnaire (RCSQ). 931 patients received the intervention. A sample of surveyed patients showed an increase in the RCSQ global score from 6.0 to 6.2 from the pre- to post- intervention periods (p = 0.041), plus increases in three of the five individual survey components. In addition, there was an improvement in the HCAHPS “quietness at night” score, from 34.1% pre-intervention to 42.5% post-intervention.
Those results are modest and we don’t know if they are sustainable or generalizable, but it is a step in the right direction.
We recommend you go back to our Patient Safety Tips of the Week for November 6, 2018 “More on Promoting Sleep in Inpatients” and March 16, 2021 “Sleep Program Successfully Reduces Delirium” and our August 2019 What's New in the Patient Safety World column “Tools for Reducing Sleep Meds in Hospitals” for more nonpharmacologic interventions to promote healthier sleep in hospitalized inpatients.
Some of our previous columns on safety issues associated with sleep meds and promoting sleep in inpatients:
August 2009 “Bold Experiment: Hospitals Saying No to Sleep Meds”
March 23, 2010 “ISMP Guidelines for Standard Order Sets”
May 2012 “Safety of Hypnotic Drugs”
November 2012 “More on Safety of Sleep Meds”
March 2013 “Sedative/Hypnotics and Falls”
June 2013 “Zolpidem and Emergency Room Visits”
August 6, 2013 “Let Me Sleep!”
June 3, 2014 “More on the Risk of Sedative/Hypnotics”
May 15, 2018 “Helping Inpatients Sleep”
June 2018 “Deprescribing Benzodiazepine Receptor Agonists”
November 6, 2018 “More on Promoting Sleep in Inpatients”
June 2019 “FDA Boxed Warning on Sleep Meds”
August 2019 “Tools for Reducing Sleep Meds in Hospitals”
March 16, 2021 “Sleep Program Successfully Reduces Delirium”
Herscher M, Mikhaylov D, Barazani S, et al. A Sleep Hygiene Intervention to Improve Sleep Quality for Hospitalized Patients. The Joint Commission Journal on Quality and Patient Safety 2021; 47(6): 343-346. Published: February 10, 2021
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