Good sleep is vital to recovery for our patients. A growing body of evidence demonstrates the significant impact of sleep disturbance on physical and mental health.
Poor sleep can affect:
- metabolism
- recovery
- repair
- inflammation
- immunity
- pharmacokinetics[1] and pharmacodynamics[2]
- mood
- overall sense of wellbeing
Our new understanding of the science of circadian rhythms (the cycle that tells our bodies when to sleep) and factors that interfere with them highlights why it is so important to account for them in our approach to care
What are we trying to achieve?
Evidence shows:
- the benefits of effective sleep for patients’ recovery, wellbeing and overall experience
- staff and patient experience are positively correlated so improving staff experience by reducing factors that hinder quality sleep (such as shift patterns, workload, anxiety etc.) has the potential to improve patient experience, whilst also reducing errors and staff burnout
Our focus on sleep aligns with the Waitemata DHB's Board priorities of improving health outcomes and enhancing patient experience. Improved sleep will promote a faster and more complete recovery for patients, improve their experience in and out of hospital, and will inevitably provide downstream cost savings.
Patient Feedback About Sleep in Hospital
Patients report that ward environments are not conducive to quality rest, and that sleep is disturbed by clinical processes such as observations and pharmaceutical regimes.
- "Got woken up when I need sleep"
- "I have no complaints about my treatment. The only complaint I have, is trying to sleep impossible!"
- "Noisy at night with lots of beeping etc from equipment making it hard to rest or sleep"
- "Could not sleep due to the noise"
What have we done?
Partnerships
Waitemata DHB has formed research partnerships with the University of Auckland, Massey University and the University of Canterbury to contribute to research literature as we trial solutions to decrease noise and increase sleep on our wards. We have conducted baseline measurement of our lighting and sound levels during the day and night, as well as conducting observational studies and patient/staff interviews to enhance our understanding of the key contributors to ward noise.
Sleep Programme
In light of our patient feedback and the current sleep research we formed a steering group with representation from the clinical (medical, nursing and allied health) and non-clinical workforce, primary and secondary care, and the WELL Foundation (DHB Fundraising arm). The group meets regularly throughout the year to identify the issues affecting sleep and to develop a strategy and lead specific activities. The issues identified fall into four broad categories, which have been used to define the domains of activity within the programme.
These are:
- Patient experience – including self-management, anxiety and stress, nutrition and hydration
- Physical environment – including noise, lighting, temperature, beds and bed-spaces
- Clinical factors and practice – including medications, observations, insomnia and other sleep disorders
- Staff Experience – including shift patterns, anxiety and stress.
SLEEP SPACE Domains of Activity
Sleep Packs
With support from the Well Foundation and Air New Zealand, sleep packs have been supplied to patients on three wards to support sleep.
The sleep packs contain:
- eye masks
- ear plugs
- information on sleep
- a chamomile tea bag
- information about Well Foundation
When the packs are handed out our nurses have a conversation with patients about sleep, giving patients an opportunity to communicate how they sleep most effectively and how night observations should be carried out.
Giving patients more control of their sleep patterns enhances patient experience and minimises surprises at night.
Observational Studies
Ward 7, an orthopaedic ward at North Shore Hospital, has participated in having baseline light and sound measured. These baseline measures help us to understand how successful specific interventions/solutions are.
Through observational studies on the ward, the staff have been able to understand:
- how ward lighting can affect patients
- what environmental factors like bin lids, cleaning regimes and phones can create noise and disturb patients' sleep
Sound measurement in a patient room
Simple interventions introduced include:
- labelling of light switches to help control the amount of lighting, especially at night
- rescheduling cleaning times
- better positioning of phones
Where to from here?
Once the baseline data has been collected, multiple interventions will be tested on the ward to decrease noise and light challenges that impact on patient sleep. The university partnerships will enable us to contribute our findings to research and trialling of specific products may also enable us to identify interventions that can be used for new wards or future renovations.
The Sleep Packs have been appreciated by patients and have enhanced sleep. In 2018 it is hoped that these packs can be rolled out across all wards.
References
- Pharmacokinetics, sometimes described as what the body does to a drug, refers to the movement of drug into, through, and out of the body - the time course of its absorption, bioavailability, distribution, metabolism, and excretion.
- Pharmacodynamics, described as what a drug does to the body, involves receptor binding, postreceptor effects, and chemical interactions. Drug pharmacokinetics determines the onset, duration, and intensity of a drug's effect.