Enhancing the Patient Experience With a Do-Not-Disturb Sleep Protocol

Hospital settings challenge restful sleep. Inadequate sleep can lead to irregular heart rates, labile blood pressures, anxiety and delirium; such complications also prolong a patient’s hospital stay King, Bailey & Kamdar, 2015; Yilmas, Sayin & Gurler, 2012; Lipitz-Snyrram, et al., 2011). Nurses can coordinate a conscious effort to promote sleep. For appropriate patients, modifying the delivery of care facilitates a period of uninterrupted sleep (Pellicane, 2014; Young, et al., 2008; Young, et al., 2009). The nurse driven program, Do Not Disturb, was developed and refined as a partnership between direct care nurses, nursing administration and hospitalists.

The program is offered to patients who are clinically stable and low risk. Nurses identify eligible patients, provide information, and enroll those who are interested. Participants have a laminated moonplaced outside their room to identify enrollment. The protocol is implemented by nursing and ancillary staff between midnight and 5:00 AM. Nurses perform hourly rounds via observation. Necessary tasks are bundled and medication schedules are coordinated with pharmacy to avoid dosing during sleep time. Environmental considerations are key: dimming lights, lowering alarms and encouraging use of ear plugs, eye masks and ambient noise. Safety is emphasized; eligibility may change if a patient’s condition changes.

Support for the program is strong. Surveys, completed by participating patients, reported that 40% slept undisturbed. However, sleep was disturbed when roommates needed attention (40%) or when the participant needed attention (20%). All felt safe during the night and all would opt to enroll again. Antidotal comments from staff indicate that while implementation requires some behaviors to change, the protocol is recognized as best patient care. Interest in the program is spreading across the hospital, as other nurses seek to replicate the program and physicians promote it with their patients.

Double occupancy rooms are unique challenges for undisturbed sleep. A pilot study will begin soon for enrolled patients with roommates, testing melatonin as a bedtime medication. Similar to other changes in clinical practice, successful implementation of the Do Not Disturb program requires clear communication and shared expectations. Restful sleep contributors to quality care and patient satisfaction. Nurses, as advocates for best practices and coordinators of patient-centered care, are poised to address patient needs and transform traditional practices.