(1271) Improving Sleep Hygiene in Pediatric Critically Ill Patients: A Quality Improvement Project

Introduction: Quality of sleep in children that are admitted to the intensive care unit (ICU) is significantly compromised, due in part to the disease severity as well as the ICU environment and poor sleep hygiene (SH). SH is a term used for good habits and behaviors that influence sleep positively. It has been shown that sleep deprivation can lead to acute delirium in children among other complications. The project aimed to increase compliance with SH by 30% in critically ill children admitted to ICU within 4 months of project initiation.

Methods: The pediatric ICU at Nicklaus Children’s Hospital, Florida consists of 36 beds. In January 2022, baseline data on SH compliance was obtained. Interventions were made following the Plan-Do-Study-Act (PDSA) model. Compliance with SH measures was assessed during night rounds at 10 pm a month after interventions were implemented. Follow-up assessments were obtained 4-months and 1-year after the last intervention.

Results: Baseline compliance with SH metrics were: blinds closed at 86.6%, television off (TVoff) at 50%, and lights off (Loff) at 66%. The first intervention consisted of sharing handouts with nurses about SH. A month later, the data showed decreased compliance in all measures except Loff which stayed at 66%. The second intervention was installing visuals in the rooms about SH to increase parental cooperation, and include the nurses as part of the internal audit team. A month later, the audits demonstrated an increase in compliance with 100% in all categories except Loff, which increased to 95%. 4-months after the second intervention, compliance remained at 94% or above in all categories except TVoff which decreased to 86%. The ICU team was re-educated on the importance of SH compliance to complete PDSA cycle 3. One year after the last intervention, SH compliance remained at 91% or higher in all categories.

Conclusions: Creating a culture and implementing practices that promote compliance with SH in a pediatric critical care unit requires a multidisciplinary effort involving families, nurses, and physicians, among other ICU staff. Periodic re-education may be necessary to maintain compliance.