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. 2022 Jun;56(6):645-655.
doi: 10.1177/10600280211043278. Epub 2021 Sep 7.

Development and Implementation of a Multicomponent Protocol to Promote Sleep and Reduce Delirium in a Medical Intensive Care Unit

Adrienne Darby  1 , Kalynn Northam  1 , C Adrian Austin  2 , Lydia Chang  2 , Stacy Campbell-Bright  1
Affiliations

Development and Implementation of a Multicomponent Protocol to Promote Sleep and Reduce Delirium in a Medical Intensive Care Unit

Adrienne Darby et al. Ann Pharmacother. 2022 Jun.

Abstract

Background: Evidence suggests that poor sleep increases risk of delirium. Because delirium is associated with poor outcomes, institutions have developed protocols to improve sleep in critically ill patients.

Objective: To assess the impact of implementing a multicomponent sleep protocol.

Methods: In this prospective, preimplementation and postimplementation evaluation, adult patients admitted to the medical intensive care unit (ICU) over 42 days were included. Outcomes evaluated included median delirium-free days, median Richards-Campbell Sleep Questionnaire (RCSQ) score, median optimal sleep nights, duration of mechanical ventilation (MV), ICU and hospital length of stay (LOS), and in-hospital mortality.

Results: The preimplementation group included 78 patients and postimplementation group, 84 patients. There was no difference in median delirium-free days (1 day [interquartile range, IQR, = 0-2.5] vs 1 day [IQR = 0-2]; P = 0.48), median RCSQ score (59.4 [IQR = 43.2-71.6] vs 61.2 [IQR = 49.9-75.5]; P = 0.20), median optimal sleep nights (1 night [IQR = 0-2] vs 1 night [IQR = 0-2]; P = 0.95), and in-hospital mortality (16.7% vs 17.9%, P = 1.00). Duration of MV (8 days [IQR = 4-10] vs 4 days [IQR = 2-7]; P = 0.03) and hospital LOS (13 days [IQR = 7-22.3] vs 8 days [IQR = 6-17]; P = 0.05) were shorter in the postimplementation group, but both were similar between groups after adjusting for age and severity of illness.

Conclusions and relevance: This report demonstrates that implementation of a multicomponent sleep protocol in everyday ICU care is feasible, but limitations exist when evaluating impact on measurable outcomes. Additional evaluations are needed to identify the most meaningful interventions and best practices for quantifying impact on patient outcomes.

Keywords: critical care; mechanical ventilators; quality assurance; sedatives; sleep disorders.

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Conflict of interest statement

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Sleep promotion algorithm for medical intensive care unit patients: Interventions provided during 3 progressive stages of sleep protocol. Abbreviation: CAM-ICU, Confusion Assessment Method for the intensive care unit.
Figure 2.
Figure 2.
Daily nursing sleep protocol checklist: Bedside checklist utilized by nursing staff to track sleep interventions provided. Abbreviation: CAM-ICU, Confusion Assessment Method for the intensive care unit.
See this image and copyright information in PMC

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