Knauert Melissa P, Redeker Nancy S, Yaggi Henry K, Bennick Michael, Pisani Margaret A
Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
Yale School of Nursing, Yale University West Campus, West Haven, CT, USA.
J Patient Exp. 2018 Sep;5(3):180-187. doi: 10.1177/2374373517747242. Epub 2018 Jan 17.
Patients in the intensive care unit (ICU) have significantly disrupted sleep. Sleep disruption is believed to contribute to ICU delirium, and ICU delirium is associated with increased mortality. Experts recommend sleep promotion as a means of preventing or shortening the duration of delirium. ICU Sleep promotion protocols are highly complex and difficult to implement. Our objective is to describe the development, pilot implementation, and revision of a medical ICU sleep promotion protocol.
is a clustered-care intervention that provides a rest period between 00:00 and 04:00. We used literature review, medical chart review, and stakeholder interviews to identify sources of overnight patient disturbance. With stakeholder input, we developed an initial protocol that we piloted on a small scale. Then, using protocol monitoring and stakeholder feedback, we revised and adapted it for unitwide implementation.
We identified sound, patient care, and patient anxiety as important sources of overnight disturbance. The pilot protocol altered the timing of routine care with a focus on medications and laboratory draws. During the pilot, there were frequent protocol violations for laboratory draws and for urgent care. Stakeholder feedback supported revision of the protocol with a focus on providing 60- to 120-minute rest periods interrupted by brief clusters of care between 00:00 and 04:00.
Four-hour blocks of rest may not be possible for all medical ICU patients, but interruptions can be minimized to a significant degree. Involvement of all stakeholders and frequent protocol reevaluation are needed for successful adoption of an overnight rest period.
重症监护病房（ICU）的患者睡眠受到严重干扰。睡眠干扰被认为会导致ICU谵妄，而ICU谵妄与死亡率增加有关。专家建议促进睡眠作为预防或缩短谵妄持续时间的一种手段。ICU促进睡眠方案非常复杂且难以实施。我们的目的是描述一个医学ICU促进睡眠方案的制定、试点实施和修订情况。
这是一项群组护理干预措施，在00:00至04:00之间提供一段休息时间。我们通过文献综述、病历审查和与利益相关者访谈来确定夜间患者干扰的来源。在利益相关者的参与下，我们制定了一个初步方案并进行了小规模试点。然后，利用方案监测和利益相关者的反馈，我们对其进行了修订并调整以便在全科室实施。
我们确定声音、患者护理和患者焦虑是夜间干扰的重要来源。试点方案改变了常规护理的时间安排，重点关注用药和实验室检查。在试点期间，实验室检查和紧急护理方面经常出现违反方案的情况。利益相关者的反馈支持对方案进行修订，重点是在00:00至04:00之间提供60至120分钟的休息时间，并穿插简短的护理群组。
并非所有医学ICU患者都能实现4小时的连续休息，但干扰可以在很大程度上降至最低。要成功采用夜间休息时间，需要所有利益相关者的参与和对方案的频繁重新评估。
