Improving Hospital Onset Delirium Rates in Adult Intensive Care Unit (ICU) Patients Through the Implementation of a Nonpharmacological Multidisciplinary Sleep Hygiene Bundle (SHB)

Date of Doctor of Nursing Practice Project Completion

Spring 4-20-2024

Faculty Advisor

Francine Snow DrPH, MSN, RN, CNE, NPD-BC

Abstract

Purpose

This quality improvement (QI) initiative aimed to implement an interprofessional multicomponent nonpharmacological sleep hygiene bundle (SHB) to reduce the monthly average incidence of delirium (MAIOD) rates from 4.16% (baseline) to less than 3.5% as measured by the Confusion Assessment Method-ICU (CAM-ICU).

Background:

The ICU's sleep architecture is defined by the frequent interruptions in the day/night cycles, negatively impacting the body's homeostatic regulatory systems. This disruption contributes to the development of circadian dysrhythmias, increasing delirium-risk, a preventable/costly condition associated with cognitive/physical complications, and increased mortality. The project took place in a 20-bed medical intensive care unit (MICU) at Houston Methodist Sugar Land (HMSL) where the MAIOD was 4.16% in 2022 exceeding the ICU leadership target of below 3.5%.

Methodology

The multidisciplinary intervention team included ICU healthcare personnel ranging from intensivists to ICU volunteers. A multicomponent nonpharmacological SHB was implemented promoting predefined day/night evidence-based interventions facilitating a balance in the circadian rhythm. Quantitative analysis involved monthly assessment of MAIOD, and weekly intervention compliance (WIC). Staff-feedback questionnaires were implemented to identify areas of improvement/challenges. PDSA cycles were employed throughout the project’s execution.

Results

Post-intervention MAIOD rates ranged between 2.36% and 2.92%; achieving ICU leadership targets. WIC was less than 50% on average. Staff questionnaire described SHB as: ‘meaningful’, ‘easy’, and ‘much needed’.

Implications

Implementing a SHB demonstrated a positive impact on reducing MAIOD rates in an ICU by improving patient quality of sleep. Further work is needed to improve intervention compliance through staff/volunteer workload leveling to increase project effectiveness in ICU settings.

Keywords

icu sleep, icu sleep bundle, sleep hygiene bundle, delirium, quality of sleep, multidisciplinary, nonphamacological, cam-icu, icu delirium, sleep hygiene

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