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