Decrease in as-needed sedative use by limiting nighttime sleep disruptions from hospital staff.
BACKGROUND
Hospital routines frequently interrupt nighttime sleep. Sedatives promote sleep, but increase the risk of delirium and falls. Few interventional trials have studied sleep promotion in medical-surgical units and little is known about its impact on sedative use.


OBJECTIVE
To determine causes of sleep disruption, and assess whether decreasing sleep disruptions lowers sedative use in medical-surgical patients.


METHODS
Interventional trial with historical controls on a medical-surgical unit of a community teaching hospital. Nurses, physicians, and patients were blinded to the measurement of as-needed sedative use.


METHODS
Consecutive eligible adults (n = 161 preintervention patients, n = 106 intervention patients).


METHODS
We developed the "Somerville Protocol," which included the establishment of an 8-hour "Quiet Time" that began with automated lights-off and lullaby; staff-monitored noise; and avoidance of waking of patients for routine vital signs and medications.


METHODS
As-needed sedative use, responses to a patient questionnaire, and responses to a modified Verran Snyder-Halpern (VSH) sleep scale.


RESULTS
Preintervention, "hospital staff " was the disturbance most likely to keep patients awake. The intervention decreased the proportion of patients reporting it from 42% to 26%, a 38% reduction (P = 0.009; 95% confidence interval [CI]: 0.0452-0.2765). Preintervention, 32% of patients received as-needed sedatives, compared to 16% with the intervention, a 49% reduction (P = 0.0041; 95% CI: 0.056-0.26), with a 62% decrease in patients over age 64 years (P = 0.005). VSH scores were unchanged.


CONCLUSIONS
Small modifications in hospital routines, especially in the timing of vital signs and routine medication administration, can significantly reduce sedative use in unselected hospital patients.
Bartick
Melissa C
MC
Department of Medicine, Harvard Medical School, Cambridge Health Alliance, Cambridge, Massachusetts 02139, USA. mbartick@challiance.org
Thai
Xia
X
Schmidt
Timothy
T
Altaye
Amsalework
A
Solet
Jo M
JM
D000368:Aged; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects; D008029:Lighting / Q000592:standards; D008297:Male; D008875:Middle Aged; D009551:Night Care / Q000379:methods*; D009622:Noise / Q000009:adverse effects / Q000517:prevention & control; D005791:Patient Care / Q000379:methods*; D012646:Self Administration; D012890:Sleep / Q000187:drug effects / Q000502:physiology; D012892:Sleep Deprivation / Q000188:drug therapy / Q000517:prevention & control*
D006993:Hypnotics and Sedatives