Improving sleep for hospital inpatients: a best practice implementation project

Introduction: Patients often experience sleep disruption in hospital, which may prolong recovery and healing. Previous studies focusing on behavior change have ignored specific context implementation factors, resulting in limited improvements in patient sleep. Objectives: The aim of this study was to improve patient sleep through the implementation of a standardized patient self-report sleep assessment scale, together with a comprehensive evidence-based nocturnal sleep guideline for patients. Methods: This study was conducted in two acute care wards in a 500-bed public tertiary referral hospital in Sydney, Australia. The study used the seven-phase JBI Evidence Implementation Framework, which is grounded in an audit and feedback process. Data were gathered through assessment of patients’ self-reported sleep and semi-structured interviews with nurses and doctors. The resulting data and the Behaviour Change Wheel (BCW) informed the context-specific implementation strategy. A follow-up audit was then used to measure the effectiveness of the implementation strategy. Results: Patients’ self-reported quality of sleep remained unchanged; however, their perception of sound levels was lower post-implementation (median 49.0 [20.5] versus 23.0 [16.2–54.0]). Use of the sleep assessment scale was low. The main barrier was that nurses perceived documentation as a burden. Doctors reported that they were unaware of the sleep assessment scale and guideline post-implementation. Conclusions: Despite there being little uptake of the sleep assessment scale, there was evidence of some changes in practice relevant to sound reduction, which is key to improving sleep quality in hospitals. Documentation burden was a barrier for the uptake of the sleep assessment scale. Spanish abstract: http://links.lww.com/IJEBH/A581