Improving Hospitalized Children's Sleep by Reducing Excessive Overnight Blood Pressure Monitoring

Abstract

BACKGROUND: Although required for healing, sleep is often disrupted during hospitalization. Blood pressure (BP) monitoring can be especially disruptive for pediatric inpatients and has few clinical indications. Our aim in this pilot study was to reduce unnecessary overnight BP monitoring and improve sleep for pediatric inpatients. METHODS: The intervention in June 2018 involved clinician education sessions and updated electronic health record (EHR) orders that enabled the forgoing of overnight BP checks. The postintervention period from July 2018 to May 2019 examined patient-caregiver surveys as outcome measures. These surveys measured inpatient sleep and overnight disruptions and were adopted from validated surveys: the Patient Sleep Questionnaire, expanded Brief Infant Sleep Questionnaire, and Potential Hospital Sleep Disruptions and Noises Questionnaire. Uptake of new sleep-friendly EHR orders was a process measure. Reported patient care escalations served as a balancing measure.RESULTS: Interrupted time series analysis of EHR orders (n pre = 493; n post = 1472) showed an increase in intercept for the proportion of patients forgoing overnight BP postintervention (150.7%; 95% confidence interval 41.2% to 60.3%; P , .001) and a subsequent decrease in slope each week (20.16%; 95% confidence interval 20.32% to 20.01%; P = .037). Statistical process control of surveys (n pre = 263; n post = 131) showed a significant increase in sleep duration for patients older than 2, and nighttime disruptions by clinicians decreased by 19% (P , .001). Annual estimated cost savings were $15 842.01. No major adverse events in patients forgoing BP were reported.CONCLUSIONS: A pilot study combining EHR changes and clinician education safely decreased overnight BP checks, increased pediatric inpatient sleep duration, and reduced nighttime disruptions by clinicians.

Objective Sleep Characteristics and Factors Associated With Sleep Duration and Waking During Pediatric Hospitalization

“…Promising interventions that use parent-facilitated relaxation and comfort strategies to promote sleep and return to sleep from wakes 53 , 54 or that optimize routine monitoring should be further explored. 55 Our previous work 56 , 57 has demonstrated sleep deprivation and effects on mood that may inhibit parents’ ability to support and care for their child during hospitalization. Development of future interventions should target the whole family and incorporate input from staff, administration, parents, and children.…”

Quasi-experimental, Nonrandomized Initiative to Minimize Sleep Disruptions among Hospitalized Children

“…This goal differed from previous studies that mainly abstained from overnight blood pressure and/or temperature monitoring. 6,11 Notably, a larger patient sample received orders to forego overnight blood pressures and/or temperatures compared to the 11% of patient nights in our study receiving the order to forego all VS. We also observed that while our intervention was intended to reduce all overnight VS, we only observed a significant reduction in the blood pressure measurements in the population with the selected order. This result may indicate that heart rate, respiratory rate, pulse oximetry, and temperature are collected without waking the patient.…”

Sleep and Circadian Disruptors: Unhealthy Noise and Light Levels for Hospitalized Pediatric Stem Cell Transplant Patients

“…21,25,26 Although environmental factors are known to be the most common sleep disruptors, the majority of sleep-promoting interventions target individuals' behaviors, not their environments. 5 Due to the known challenges with sustaining interventions targeting patients or providers, institutions should make systematic changes that prioritize sleep and circadian function (e.g., reducing overnight noise or consolidating procedures 7,27,28 ). 29 Almost all section chiefs of hospital medicine rate patient sleep as important, but fewer than half of their hospitals have adopted sleep friendly practices.…”