sleep for health in hospital ‘shh’ a quality improvement ... · • lack of sleep also affects...

SleepforHealthinHospital‘SHH’Aqualityimprovementproject

JoMcCubbin

SleepMedicineClinicalNurseSpecialist

PIERConference:Sept2017,WinchesterGuildhall

THREEREASONSTOPROMOTEOPTIMALSLEEPINHOSPITAL

1.Stresstolerance• Brokensleepinchildrenincreasescortisolrelease,raisesstressandalters

mood• Lackofsleepalsoaffectsemotionalcontrol,decisionmakingandmoodin

parents• Mothersofchildrenwithatopiceczema- 39minslesssleeprelatedtoanxiety

anddepression

2.Sleeptoheal• Research: 80healthyadultvolunteers:4hrsofsleepnightbeforefluvaccine:

antibodytitres>50%lowerthancontrols(Spiegeletal2002)

3.Sleepforpaintolerance• Lackofsleepincreasespainsensitivity• Despitebestcare,children’swardsarenotcompletelypainfreeenvironments

What do we know about sleep in hospital?

Sticklandetal.ArchDisChild2016;101(6):546-51

Effectonchild‘Hedidnotsleepenoughduringthenightandwasverycrankyand

miserablethenextday’‘Shealwaystriestostayupaslongaspossiblebecausethereissomuchgoingoninhospital’

Effectonparents‘IthinkitmakesyouabitmoreemotionalandIthinkitmakesit

hardertodealwiththings.It’sthatmentalkindofbuild-up,iteatsawayatyoueventually.’

Tuning in…sound levels

Soundlevelsatbedside

Highest 10% sound levelsSound level LAeq

WHOrecommendationsforhospitalwards:guidelines• Backgroundsoundlevelshouldnotexceed30dB• Individualnoiseeventsshouldnotexceed45dB• Ideally,patientsshouldnotbeexposedtonoiseabove35dB

Sleep..a victimofchild-friendlywardenvironments?

• Lights out?• Visiting times? • Non-stop entertainment?

Charityfundedproject

AIMS

• Toachieveaculturethatrespectssleepalongsidesafecare

• Toachievemeasurablechangeinourwardenvironments

• Tobeaflagshipforhealthysleepinhospitalanddisseminatelearningtootherhospitals

PLAN:toolkitidentify&principles

• Simpletointegrateintowardroutine

• Visual cuesusingrecognisablelogo

• Acceptabletoparentsandstaff

• Cleartoall

Projectidentity:‘Pleaserespectchildren’s

needforsleep’

DO:Education:changingstaffcultureInteractive20minpresentation>250staffhavebeentrainedWhatstaffsaid:Didn'tappreciatehowmuch

sleepdeprivationaffectedchildren&theirparents’

..itwasn’tsomethingIhadreallyconsidered

…renoiselevelsontheward-shocking!

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Before After

Commitment to promoting healthy sleepNotatall

Neutral

QuitecommittedVerycommitted

Do:Educating&empoweringfamilies

Do:Environmentalchange• Soundlevelmonitorsatnursingstations

• Illuminatesabove45dBthreshold• Canbecontinuouslyrecordedanddownloaded

• Redtorchesfornighttimemedicationadministrationandobservations

DO:Bedtimesign

DO: TheSHHflag– promotingbehaviourchange

EVALUATE:PilotinChildren’sCancerwardresultedin:

• Simplificationofprotocol- removalofchecklist• Parentpower!- newnapsign

EVALUATE:Noiselevels• Mediansoundlevelsmeasured

across3nights=46.4dB• Thiscomparesto59.6dB

beforetheintroductionoftheprogramme

• Planforongoingprogrammeoffeedbacktowards

Culturechange:safecarethatrespectssleep

Finalthoughts..

Acknowledgements• DrCathyHill- Honorary

Consultantinsleepmedicine

• AmyAinsworth– Project

Manager

• Steeringgroupmembers

• SouthamptonHospitalcharity

Questions?

"Insomnia, Johnson?"

For more information about implementing SHH in your hospital contact:

SHH@uhs.nhs.uk

References• Faraut B,LégerD,Medkour T,etal.Nappingreversesincreased

painsensitivityduetosleeprestriction.PLoS One.201527;10(2):e0117425.

• MooreK,DavidTJ,MurrayCS,ChildF,ArkwrightPD (2006).Effectofchildhoodeczemaandasthmaonparentalsleepandwell-being:aprospectivecomparativestudy.BritishJournalofDermatology;154(3):514-8.

• Raikkonen K,MatthewsKA,Pesonen AK,etal.Poorsleepandalteredhypothalamic-pituitary-adrenocorticalandsympatho-adrenal-medullarysystemactivityinchildren.JClin EndocrinolMetab.2010;95(5):2254-61.

• SpiegelK,SheridanJF,VanCauter E.Effectofsleepdeprivationonresponsetoimmunization.JAMA.2002;288:1471-2.