1197 Quiet at Night: A Nurse-led Quality Improvement Project to Reduce Nighttime Environmental Disruptions in a VA Subacute Rehabilitation Setting

Abstract Introduction Environmental factors (e.g., noise) can impact sleep quality in subacute rehabilitation settings, which can further impact treatment progression and functional recovery. This nurse-led quality improvement project sought to implement the VA Quiet at Night initiative by providing patient resources to reduce noise, establishing quiet hours, and discussing sleep goals with veterans. Methods Project Champions were identified from Nursing Staff prior to the start of implementation on VA Boston’s subacute rehabilitation unit. This unit provides short-term skilled nursing or rehabilitation care (i.e., ≤90 days) following acute injuries or illnesses. Veterans were offered “Quiet at Night” items, including headphones, sleep masks, ear plugs, “Quiet Please” door hangers or white noise machines. Veterans answered 5-item feedback surveys about quiet items, quiet hours, sleep goals discussions with their care team, sources of noise, and suggestions for reducing noise. Feedback surveys were collected by Nurse Champions on the first day of every month for 6 months. Descriptive and frequency analyses were used to describe preliminary results overall and at the baseline and 6-month timepoints. Results Feedback surveys (N=96) were collected over a 6-month period with an average of 16 surveys per month (Mean=16±3.9; Range=13-23). Overall, 60.4% of veterans received the “Quiet at Night” items with improvements from baseline (46.2%) to 6-months (93.3%); 74.0% reported awareness of daily quiet hours with improvements from baseline (61.5%) to 6-months (93.3%); and 45.8% reported discussing sleep goals with their care team with improvements from baseline (38.5%) to 6-months (66.7%). Veterans identified equipment (27.1%) (e.g., medical equipment, TV’s, A/C’s) as the primary source of noise with the most common suggestion to close doors or courtesy curtains (9.4%). Notably, one-third of all veterans reported no noise concerns (35.4%) and almost half did not have suggestions for change (49.0%) during implementation. Conclusion Preliminary results demonstrated improvements in access to noise-reducing resources, patient awareness of quiet hours, and discussions of sleep goals with providers within the first 6-months of this quality improvement project. Nurse-led innovations may be effective in reducing environmental noise in subacute rehabilitation settings, which may have important implications for prioritizing sleep in this care setting. Support (if any)