Protecting Sleep to Reduce Delirium in Patients 65 Years and Older in the ICU

Protecting Sleep to Reduce Delirium in Patients 65 Years and Older in the ICU PURPOSE This quality improvement (QI) project aimed to reduce the incidence of delirium by 30% through a nurse-initiated, non-pharmacological sleep improvement protocol in the ICU. BACKGROUND This project was implemented in a large healthcare organization in Houston, Texas, in a 16-bed Intensive Care Unit. METHODOLOGY A pre- and post-intervention study was conducted in the ICU over a period using Plan-Do-Study-Act (PDSA) cycles. Baseline delirium (CAM-ICU) and sleep quality (RCSQ) assessments were obtained during Phase 1. Environmental adaptations, such as low lighting, noise reduction, staff education, and patient education, were among the interventions. Directed training and ongoing support minimized noncompliance by patients and staff. RESULTS Delirium decreased by 28 percent from baseline to 18 percent after intervention (* p < 0.01). Patients experienced improved sleep. Nurses indicated improved confidence, and patient satisfaction scores were significantly higher. Sleep quality: The mean RCSQ scores improved (4.2 to 6.8/10, p = 0.003). IMPLICATIONS The results highlight the effectiveness of nurse-managed, drug-free interventions to prevent ICU delirium in older patients. Staff engagement and education were essential in addressing challenges to success. Improvement over time necessitates leadership support, continued education, and integration into standard ICU practices. Dissemination can improve patient outcomes and reduce total cost. CONCLUSION Nurse-implemented sleep hygiene techniques are effective and long-term interventions that enhance ICU care. Quality Improvement, augmented education, and continuous assessment of long-term cognitive outcomes are the pathways to future progress.