LAUSR

Background Sleep is an essential biological function vital for physiological rest, healing and emotional well-being. Sleep disruption, defined as interruptions or alterations to the normal sleeping patterns, is commonly seen in patients and caregivers with lengthy hospital stays such as patients undergoing hematopoietic stem cell transplant (HSCT). Sleep disruption in the caregivers of hospitalized patients can lead to increased stress and fatigue, decrease quality of life and ultimately affect the caregiver ability to support their loved one. Methods Through a longitudinal observational cohort study, the quality and quantity of sleep in pediatric patients undergoing HSCT and their caregivers was studied; we identified a high level of sleep disturbance utilizing actigraphy and recounted poor sleep through qualitative assessments. We then performed a cross sectional focus group analysis of patients, caregivers and medical staff to identify the factors associated with poor sleep. The global aim of our quality improvement initiative was to improve sleep quality in HSCT patients and caregivers. The smart aim of our project was to decrease nighttime noise from 46 decibels (dB) (mean baseline data) to 38dB (WHO recommends night outside noise of less than 40dB) in a 6 month period and increase sleep efficacy from a mean of 60 % (combined patient and caregiver) to 90% in the following 6 month period. We worked on achieving this goal through an overnight nighttime sleep hygiene bundle to decrease sleep disruption along with reduction of the hallway nighttime noise (9pm-7am). Results The most common factors associated with sleep disruption were noisy room entries, overnight trash pulls, loud hallway noise and noisy hospital staff. A simplified failure mode analysis identified four main key drivers; reliable nighttime awareness system, quiet nighttime nursing system, unobtrusive nighttime cleaning process and nighttime awareness maintenance system. Several PDSA (plan-do-study-act) interventions for each key driver took place and were adapted. The overnight mean dB decreased to 42dB (9% reduction). Overnight noise spikes above 60dB have decreased from a mean of 271 spikes to a mean of 151 spikes (44% reduction). Percentage of sleep efficacy results and follow up of quantitative and qualitative sleep assessments of patients and caregivers will be available by February 2019. Conclusions With a quality improvement initiative, we identified factors that negatively impact sleep and performed interventions that successfully mitigate these factors, leading to improved quality of sleep in HSCT patients and their caregivers.