Lehigh Valley Health Network LVHN Scholarly Works Patient Care Services / Nursing Sleep Promotion by Clustering Care Arielle Cratsenberg BSN, RN Lehigh Valley Health Network, [email protected] Pamela Fisher BSN, RN Lehigh Valley Health Network, [email protected] Casey Herrera BSN, RN Lehigh Valley Health Network Follow this and additional works at:http://scholarlyworks.lvhn.org/patient-care-services-nursing Part of theNursing Commons Published In/Presented At Cratsenberg, A., Fisher, P., & Herrera, C. (2015, February 23).Sleep Promotion by Clustering Care.Poster presented at: LVHN UHC/ AACN Nurse Residency Program Graduation, Lehigh Valley Health Network, Allentown, PA. Cratsenberg, A., Fisher, P., & Herrera, C. (2015, June 8).Sleep Promotion by Clustering Care.Poster presented at: Philadelphia Area Magnet Consortium Conference, Lankenau Hospital. Cratsenberg, A., Fisher, P., & Herrera, C. (2015, October 21).Sleep Promotion by Clustering Care.Poster presented at: UHC Nurse Residency Program Webinar. This Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by an authorized administrator. For more information, please [email protected]. Sleep Promotion by Clustering Care Arielle Cratsenberg, BSN, RN Pam Fisher, BSN, RN Casey Herrera, BSN, RN Background • Sleep disturbances are associated with negative outcomes such as increased fatigue, negative moods, and periods of misperception and disorientation. • Sleep quality has a restorative function, promotes health, and provides a feelings of well-being on mind and body. • Florence Nightingale believed it is good nursing care to avoid waking the patient at night whether it be intentional or unintentional. • HCAHPS scores are markers for funding at LVHN. HCAHPS Survey Question During this hospital stay, how often was the area around your room quiet at night? ▪ 1 Never ▪ 2 Sometimes ▪ 3 Usually ▪ 4 Always Significance FY 2015 HCAHPS Data Jordan - Med Surg Division Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Target YTD YTD %ile Rollup 73.0 74.4 75.0 76.9 74.8 74.0 74.2 73.1 74.6 n= 75 67 68 80 67 77 99 533 Rate Hospital 76.0 74.6 75.0 83.8 79.1 75.3 75.8 71.2 77.1 73 Recommend 72.7 74.6 76.5 77.5 79.4 72.4 81.4 76.5 61 Comm w/nurses 76.7 77.5 80.6 82.8 78.9 79.3 82.0 78.7 79.8 50 Courtesy/Respect 81.8 80.9 88.4 91.0 85.3 83.5 89.0 85.9 42 Listen Carefully 75.3 75.0 77.9 78.8 76.5 77.2 80.0 77.4 57 Explain Well 73.1 76.5 75.4 78.8 75.0 77.2 77.0 76.2 51 Response of staff 67.9 59.6 75.4 70.8 71.9 68.2 62.2 66.6 67.7 56 Call Button Help 64.8 65.6 72.2 69.6 73.8 64.9 57.8 66.3 60 Help toileting 71.1 53.7 78.6 72.0 70.0 71.4 66.7 69.2 54 Comm w/doctors 75.0 83.6 73.4 79.6 78.8 80.6 81.4 81.4 79.0 31 Courtesy/Respect 80.8 88.1 81.2 84.6 88.1 89.9 91.8 86.5 41 Listen Carefully 76.6 83.6 73.9 74.0 82.1 74.7 79.6 77.7 35 Explain Well 67.5 79.1 65.2 80.3 66.2 77.2 72.7 72.7 23 Hospital Environment 70.8 71.2 71.7 63.4 65.7 72.6 65.3 66.7 68.5 61 Cleanliness 81.8 75.8 79.7 73.1 73.1 75.9 71.0 74.7 75.6 61 Quietness 59.7 66.7 63.8 53.8 58.2 69.2 59.6 58.7 61.4 59 Pain Management 70.3 69.6 77.0 76.0 63.4 70.0 75.8 71.2 72.0 56 Well Controlled 60.7 58.8 66.0 69.2 51.2 60.0 68.8 62.5 44 Staff do everything 80.0 80.4 88.0 82.7 75.6 80.0 82.8 81.5 65 Medicine 61.5 67.7 61.4 65.9 71.2 56.1 63.3 63.6 63.8 52 Explain Meds 75.0 83.3 70.5 78.8 80.0 77.3 78.1 77.6 49 Side Effects 48.1 52.1 52.3 52.9 62.5 34.9 48.4 50.0 52 Discharge 85.7 91.0 85.5 92.6 89.0 89.6 87.8 85.4 88.7 67 Help Discussed 84.3 90.2 78.8 93.3 89.1 92.2 87.9 88.0 78 Prob To Look For 87.1 91.8 92.3 91.8 88.9 87.1 87.8 89.5 43 PICO QUESTION In older adult, medical-surgical patients, does clustering patient care activities between the hours of 2200 and 0700 as opposed to normal care provision affect sleep satisfaction. P- Older adult medical-surgical patients I- Clustering patient care from 2200-0700 C- Normal care providing routines O- Less sleep interruptions. TRIGGERs based on Iowa Model? ▪ Problem Trigger (Problem trigger) • Elderly hospitalized patient’s sleep is affected by night time sleep interruptions. This causes sleep deprivation and decreased patient satisfaction with hospital stay. • LVHN utilizes PressGaney and HCAHPS scores to determine if patients are satisfied with their sleep while in the acute care setting. These surveys are completed by hospitalized patients who rate the quality of care received including sleep satisfaction. EVIDENCE  Bartick, et al. (2010) identified that patients on a medical-surgical floor reported fewer sleep disturbances and less need for sedatives as a result of interventions designed to protect their ability to sleep such as clustering of care.  Flaherty (2008) stated that the most common nighttime interruptions are because of phlebotomy, medication administration and vital signs.  The vulnerability of the older adult makes them a perfect target to experience sleep disturbances. Iatrogenic events such as falls, functional decline, delirium, hospital acquired infections occur more frequently when a patient’s sleep/wake cycle is disturbed. Current Practice at LVHN ▪ There is no standard of practice, at this time which addresses the need for sleep hygiene practices and promotion of uninterrupted sleep. ▪ The “Quiet Time Initiative” promotes a designated sleep schedule starting at 2100 throughout the entire hospital. Lights are dimmed in hallways of units and voices are expected to be lowered. This does not address the tasks that patients require throughout the night like medication administration, vital signs, and phlebotomy. IMPLEMENTATION 3. Design (EBP) Guideline(s)/Process ▪ Phase I • Select patients who meet our age and orientation criteria: >65 years of age and oriented x3 with no underlying dementia. • Complete pre survey. Data information includes patient’s normal sleep schedule and night time routines while at home versus the hospital. ▪ Phase II • Educate staff (RN’s and TP’s of 6C, 4K, 6K) about LVHN’s policies related to telemetry, vital sign frequency, quiet time initiative, and clustering care. ▪ Phase III • Select patients who meet our age and orientation criteria: >65 years of age and oriented x3 with no underlying dementia. • Complete post survey. Data information includes patient’s normal sleep schedule and night time routines while at home versus the hospital.