Acute Care of Elders Sleep Project

Background

Sleep disruption is common in hospitalized patients due to interruptions from staff and other patients, discomfort from medical devices, and symptoms of their medical conditions.¹ In older adults, sleep disruption can lead to cardiometabolic derangements (e.g., increased blood sugar and blood pressure) and increased risk of delirium.² Loss of sleep can thus lead to downstream effects like worsening polypharmacy, slowed recovery, and even loss of independence.² Non-pharmacologic sleep interventions can be effective in the hospital setting and are preferred over pharmacologic sleep aides.²

Purpose

We are proposing a quality improvement project to improve sleep quality for patients admitted to the 21-bed Acute Care of Elders unit including validated educational modules for unit staff, sleep kits, and evening “tuck-in rounds”. This project will be designed to improve patient outcomes in real-time and will use a quality improvement PDSA framework to adjust interventions based on patient responses. There is currently no required assessment of patient sleep quality or quantity in our medicine units. Working with our colleagues in sleep medicine, we will start using a short subjective sleep quality assessment for nurses to complete and document after their morning bedside shift report. This survey will be completely de-identified and use a modified insomnia severity index to assess sleep quality, circadian rhythm changes, and note mental status changes in the last 24 hours. We will collect data on all patients with this assessment tool, first to establish a baseline for patients on the unit, and then to document response to our interventions. 

The first intervention will be education-based with eight short evidence-based sleep modules for all unit staff including nurses, aides, and providers. These modules have already been studied in the palliative care population³ and are paired with handouts and posters to remind staff of key learning points. The completion of these modules will be incentivized with continuing education credits and a gift card of $20 per staff member. There will be competency-based pre and post-test surveys to evaluate the educational effectiveness of the modules. This intervention will also require some funds to hire an information technology contractor to ensure the modules run effectively online. 

Our second intervention will involve distributing sleep kits to all patients on the unit. These kits will contain a pamphlet on best sleep practices as well as a sleep mask, earplugs, aromatherapy sachets, socks, etc. The final intervention will be to ask our Hospital Elder Life Program volunteers to assist with nightly “tuck-in rounds” which will include closing blinds, providing warm tea and socks, and counseling on best sleep practices, and playing soothing music. Throughout each intervention, scores from the bedside assessment of sleep quality will be monitored to assess if overall sleep quality on the unit is improving. The goal of this project is to improve the sleep of older adults during their inpatient stay to reduce risk of delirium and promote faster recovery.

1. Wesselius HM, van den Ende ES, Alsma J, Ter Maaten JC, Schuit SCE, Stassen PM, de Vries OJ, Kaasjager KHAH, Haak HR, van Doormaal FF, Hoogerwerf JJ, Terwee CB, van de Ven PM, Bosch FH, van Someren EJW, Nanayakkara PWB; “Onderzoeks Consortium Acute Geneeskunde” Acute Medicine Research Consortium. Quality and Quantity of Sleep and Factors Associated With Sleep Disturbance in Hospitalized Patients. JAMA Intern Med. 2018 Sep 1;178(9):1201-1208. doi: 10.1001/jamainternmed.2018.2669. PMID: 30014139; PMCID: PMC6142965.

2. Stewart NH, Arora VM. Sleep in Hospitalized Older Adults. Sleep Med Clin. 2018 Mar;13(1):127-135. doi: 10.1016/j.jsmc.2017.09.012. Epub 2017 Nov 10. PMID: 29412979; PMCID: PMC5880551.

3. Capezuti E, Zadeh RS, Brigham MA, Dias BA, Kim BC, Lengetti E, Erikson B, Swezey N, Krieger AC. Development and palliative care staff reactions to a sleep regulation educational intervention. BMC Palliat Care. 2022 Jan 21;21(1):12. doi: 10.1186/s12904-022-00902-x. PMID: 35062933; PMCID: PMC8780339.

4. Praharaj SK, Gupta R, Gaur N. Clinical Practice Guideline on Management of Sleep Disorders in the Elderly. Indian J Psychiatry. 2018 Feb;60(Suppl 3):S383-S396. doi: 10.4103/0019-5545.224477. PMID: 29535472; PMCID: PMC5840912.

Prof. Emily Coskun, MD is an Assistant Professor of Clinical Medicine and Medical Director, Acute Care of Elders (ACE) Unit at Weill Cornell Medicine.

The lecture will be held via Zoom. 

Meeting ID: 942 6721 2489 
Passcode: 891484