PowerPoint Presentation
Sleep Promotion in the ICU:Implementation of Evidence
Mindy Stites MSN, APRN, ACNS-BC, ACCNS-AG, CCNS, CCRNCritical
Care Clinical Nurse Specialist Steps in the EBP process 1.
Cultivate a spirit of inquiry. 2. Ask a burning clinical question.
3. Collect the most relevant and best evidence. 4. Critically
appraise the evidence. 5. Integrate evidence with clinical
expertise, patient preferences, and values in making a practice
decision or change. 6. Evaluate the practice decision or change. 7.
Disseminate EBP results.
Step 1: Cultivate a Spirit of Inquiry
Step 2: Ask a Burning Clinical QuestionDoes the implementation
of a sleep promotion protocol in critically ill patients reduce
rates of delirium and increase hours slept?
Step 3: Collect the Best EvidenceStudies suggest that ICU
patients get only 1-5 hours of sleep per night, with a mean of 4.5
hours (Elliott, 2011) Sleep architecture is also affectedMarked
deficits in slow wave sleep (restorative sleep)Abolished or reduced
REM sleep (Drouot et al, 2008)Sleep is associated with promotion of
healing, hormone regulation, delirium, and participation in
care
Literature Review
We have been working on this for 18 months on the 6th floor ICUs
61 and 63 initiated the sleep bundle in January of 2014 and have
not had any patient events We have had positive feedback from
patients and nurses since implementing the sleep bundle, and have
since rolled it out in the SICU as well.
6Step 4: Critically Appraise the EvidenceFindings:Limited
literatureMinimal riskRight thing to do
Study OutlineImplement a protocolized sleep promotion bundle in
2/3 medical ICU unitsEvaluate:SafetyComplianceEffect on delirium
rates, overall sleep qualitySpread change
Step 5: Integrate evidence with clinical expertise, patient
preferences, and values in making a practice decision or change
Exclusion Criteria 1.Frequent interventions required 2.Receiving
mechanical ventilation on continuous sedation drip (Versed,
Propofol, Precedex)3.Undergoing resuscitation for shock4. Frequent
titration of medications that require extensive monitoring5.
Presence of stage II or greater pressure ulcer (relative
contraindication)6. Spinal cord injuries with limited or no ability
to alter position independently7. Safety concerns identified by the
RN
(suctioning, neuro checks, direct recoveries, serial labs, AWAS,
increased FIO2 requirements requiring intervention, ect)Versed,
Propofol , PrecedexHemodynamic instability requiring frequent
titration of pressors, fluid resuscitation and greater than q 1 hr
NIBP monitoringEx: esmolol, diltilazem
** All medsurg/tele patients immediately qualify provided they
dont require any of the frequent interventions above10Step 6:
Evaluate the practice decision or change
Pre-DataPost-Data
Pre-DataPost-Data
Pre-DataPost-DataDelirium Impact
Lessons Learned Frontline, multidisciplinary staff are CRITICAL
participants in an EBP projectData collection is much more
difficult than you think, but extremely important Evidence to back
practice is limited, especially in nursingOk to test and retest
Conclusion
ReferencesElliott R, McKinley S, & Cistulli P. (2011). The
quality and duration of sleep in the intensive care setting: An
integrative review. International Journal of Nursing Studies 48:
384-400. Drouot X, Cabello B, dOrtho M, Brochard L. (2008). Sleep
in the intensive care unit. Sleep Medicine Reviews 12:
391-433.Huang H et al. (2015). Effect of oral melatonin and wearing
earplugs and eyemasks on nocturnal sleep in healthy subjects in a
simulated intensive care unit environment: which might be a more
promising strategy for ICU sleep deprivation? Critical Care
19:124Bourne R, Mills G, Minelli C. (2008). Melatonin therapy to
improve nocturnal sleep in critically ill patients: encouraging
results from a small randomized controlled trial. Critical Care
12(2):R52
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