Developing, Implementing, and Evaluating a Multifaceted Quality Improvement Intervention to Promote Sleep in an ICU

• Type of Material: Article
• Authors: Biren B. Kamdar, Johns Hopkins University; Jessica Yang, Johns Hopkins University; Lauren M. King, Johns Hopkins University; Karin J. Neufeld, Johns Hopkins University; O. Joseph Bienvenu, Johns Hopkins University; Annette M. Rowden, Johns Hopkins University; Roy G. Brower, Johns Hopkins University; Nancy Collop, Emory University; Dale M. Needham, Johns Hopkins University
• Language: English
• Date: 2014-11-01
• Publisher: SAGE Publications (UK and US)
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2013 by the American College of Medical Quality.
• Final Published Version (URL): http://dx.doi.org/10.1177/1062860613509684
• Title of Journal or Parent Work: American Journal of Medical Quality
• ISSN: 1062-8606
• Volume: 29
• Issue: 6
• Start Page: 546
• End Page: 554
• Grant/Funding Information: The authors received the following financial support for the research, authorship, and/or publication of this article: During this project, Dr Kamdar was supported by a Ruth L. Kirschstein National Research Service Award from the National Institutes of Health (F32 HL104901).
• Keywords: program development; VALIDITY; cognition; quality improvement; SEDATION; sleep; Science & Technology; delirium; DELIRIUM; Health Care Sciences & Services; ENVIRONMENTAL NOISE; MECHANISMS; MECHANICALLY VENTILATED PATIENTS; INTENSIVE-CARE-UNIT; program evaluation; DISRUPTION; outcome assessment; intensive care unit; RISK-FACTORS; RELIABILITY; Life Sciences & Biomedicine
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Critically ill patients commonly experience poor sleep quality in the intensive care unit (ICU) because of various modifiable factors. To address this issue, an ICU-wide, multifaceted quality improvement (QI) project was undertaken to promote sleep in the Johns Hopkins Hospital Medical ICU (MICU). To supplement previously published results of this QI intervention, the present article describes the specific QI framework used to develop and implement this intervention, which consists of 4 steps: (a) summarizing the evidence to create a list of sleep-promoting interventions, (b) identifying and addressing local barriers to implementation, (c) selecting performance measures to assess intervention adherence and patient outcomes, and (d) ensuring that all patients receive the interventions through staff engagement and education and regular project evaluation. Measures of performance included daily completion rates of daytime and nighttime sleep improvement checklists and completion rates of individual interventions. Although long-term adherence and sustainability pose ongoing challenges, this model provides a foundation for future ICU sleep promotion initiatives.