Sleep Promotion in the ICU: Implementation of Evidence Mindy Stites MSN, APRN, ACNS-BC, ACCNS-AG,...
-
Upload
cornelius-bradley -
Category
Documents
-
view
221 -
download
3
Transcript of Sleep Promotion in the ICU: Implementation of Evidence Mindy Stites MSN, APRN, ACNS-BC, ACCNS-AG,...
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
18