Wednesday, April 16, 2014

Dedicated “Sleep Time” in ICUs May Prevent Delirium, Shorten Hospital Stays

Patients who had a four-and-a-half hour window of uninterrupted sleep experienced less delirium and shorter hospitalizations during a protocol study conducted at a Philadelphia-area hospital intensive care unit (ICU).

An interprofessional team, including a nurse, pharmacist, dietitian, and respiratory therapist, developed the protocol. The team was led by Critical Care Director Dominic Valentino at Mercy Fitzgerald Hospital, the Philadelphia Inquirer reports. 

During the study, ICU room lights were turned off and loud talking was prohibited from midnight until 4:30am to protect patients' sleep. During those hours, nurses monitored patients remotely and all routine bloodwork, medications, and exams were halted, unless a patient's medical condition required immediate intervention.

One hundred twenty-five patients were put on the protocol during January and February of 2013. Patients who had uninterrupted nightly sleep for more than half of their time in the ICU shortened their stays there by approximately four-and-a-half days. Researchers also found that these patients averaged two days of delirium, compared with three–and-a-half days for patients who got uninterrupted nightly sleep for less than half of their stays.

The successful protocol has now been adopted at other Mercy Health System hospitals in West Philadelphia, East Norriton, and Northeast Philadelphia. Hospitals are particularly open to it because it is effective and there is no cost to implementing the protocol, Valentino told the Inquirer.

A recent study funded by INQRI and published in Critical Care Medicine found that implementing a set of practices to encourage patients’ mobility and reduce sedation effectively reduces delirium and the need for a ventilator, and increases patients’ mobility during hospitalization. This, in turn, decreases weakness.

The INQRI study tested the effectiveness and safety of implementing a bundled set of evidence-based practices into everyday practice in the ICU. It is called the ABCDE bundle, for Awakening and Breathing Coordination, Delirium monitoring and management, and Early mobility.

The research team, led by Michele Balas and William Burke, examined the results of having a nurse-led interdisciplinary team use the bundle with roughly 150 patients in five adult ICUs, one step-down unit, and an oncology/special care unit in a medical center; researchers compared their outcomes with those of a similar group of patients in the same setting prior to implementation of the bundle.

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