Baptist Health, Jacksonville, FL, USA.
AdventHealth Orlando, Orlando, FL, USA.
Ann Pharmacother. 2021 Jul;55(7):863-869. doi: 10.1177/1060028020973198. Epub 2020 Nov 9.
Sleep improvement protocols are recommended for use in the intensive care unit (ICU) despite questions regarding which interventions to include, whether sleep quality or duration will improve, and the role of pharmacists in their development and implementation.
To characterize the impact of a pharmacist-led, ICU sleep improvement protocol on sleep duration and quality as evaluated by a commercially available activity tracker and patient perception.
Critical care pharmacists from a 40-bed, mixed ICU at a large community hospital led the development and implementation of an interprofessional sleep improvement protocol. It included daily pharmacist medication review to reduce use of medications known to disrupt sleep or increase delirium and guideline-based recommendations on both environmental and nonpharmacological sleep-focused interventions. Sleep duration and quality were compared before (December 2018 to December 2019) and after (January to June 2019) protocol implementation in non-mechanically ventilated adults using both objective (total nocturnal sleep time [TST] measured by an activity tracker (Fitbit Charge 2) and subjective (patient-perceived sleep quality using the Richards-Campbell Sleep Questionnaire [RCSQ]) measures.
Groups before (n = 48) and after (n = 29) sleep protocol implementation were well matched. After protocol implementation, patients had a longer TST (389 ± 123 vs 310 ± 147 minutes; = 0.02) and better RCSQ-perceived sleep quality (63 ± 18 vs 42 ± 24 mm; = 0.0003) compared with before implementation.
A sleep protocol that incorporated novel elements led to objective and subjective improvements in ICU sleep duration and quality. Application of this study may result in increased utilization of sleep protocols and pharmacist involvement.
尽管关于应包含哪些干预措施、睡眠质量或持续时间是否会改善以及药剂师在其制定和实施中的作用存在疑问，但仍建议在重症监护病房（ICU）中使用改善睡眠的方案。
通过使用商业可用的活动追踪器和患者感知来评估，描述由药师主导的 ICU 睡眠改善方案对睡眠持续时间和质量的影响。
一家大型社区医院 40 张床位的混合 ICU 的临床药师主导了跨专业睡眠改善方案的制定和实施。它包括每日药师进行药物审查，以减少使用已知会扰乱睡眠或增加谵妄的药物，并根据指南提供有关环境和非药物性以睡眠为重点的干预措施的建议。使用客观（活动追踪器（Fitbit Charge 2）测量的总夜间睡眠时间[TST]和主观（患者使用 Richards-Campbell 睡眠问卷[RCSQ]感知的睡眠质量）指标，比较方案实施前（2018 年 12 月至 2019 年 12 月）和实施后（2019 年 1 月至 6 月）非机械通气成人的睡眠持续时间和质量。
方案实施前（n = 48）和后（n = 29）的两组患者匹配良好。与实施前相比，实施方案后患者的 TST 更长（389 ± 123 分钟 vs 310 ± 147 分钟； = 0.02），RCSQ 感知的睡眠质量更好（63 ± 18 毫米 vs 42 ± 24 毫米； = 0.0003）。
纳入新元素的睡眠方案可改善 ICU 睡眠持续时间和质量，无论是客观指标还是主观指标。应用这项研究可能会增加睡眠方案的应用和药剂师的参与度。
