Optimizing Oral Medication Schedules for Inpatient Sleep: A Quality Improvement Intervention

Abstract

OBJECTIVES: Hospitalized children experience frequent nighttime awakenings. Oral medications are commonly administered around the clock despite the comparable efficacy of daytime administration schedules, which promote sleep. With this study, we evaluated the effectiveness of a quality improvement initiative to increase the proportion of sleep-friendly antibiotic administration schedules. METHODS: Interprofessional stakeholders modified computerized provider order entry defaults for 4 oral antibiotic medications, from around the clock to administration occurring exclusively during waking hours. Additionally, care-team members received targeted education. Outcome measures included the proportion of sleep-friendly administration schedules and patient caregiver–reported disruptions to sleep. Pre- and posteducation surveys were used to evaluate education effectiveness. Balancing measures were missed antibiotic doses and related escalations of care. RESULTS: Interrupted time series analysis revealed a 72% increase (interceptpre: 18%; interceptpost: 90%; 95% confidence interval: 65%–79%; P < .001) in intercept for percentage of orders with sleep-friendly administration schedules (orders: npre = 1014 and npost = 649). Compared with preeducation surveys, care-team members posteducation were more likely to agree that oral medications scheduled around the clock cause sleep disruption (resident: 71% pre, 90% post [P = .01]; nurse: 63% pre, 79% post [P = .03]). Although sleep-friendly orders increased, patient caregivers reported an increase in sleep disruption due to medications (pre 28%, post 46%; P < .001). CONCLUSIONS: A simple, low-cost intervention of computerized provider order entry default modifications and education can increase the proportion of sleep-friendly oral antibiotic administration schedules for hospitalized children. Patient perception of sleep is impacted by multiple factors and often does not align with objective data. An increased focus on improving sleep during hospitalization may result in heightened awareness of disruptions.

Use of machine learning to identify risk factors for insomnia

“…Multiple papers have found difficulty falling asleep and decreased hours of sleep with increased depression [41][42][43][44][45][46][47][48][49][50][51][52][53]. Additionally, depression has bene linked to lower quality sleep and increased day time exhaustion [31,34,46,54,55]. There is also strong literature evidence for the link between weight and sleep disorders [4].…”

“…While medications have shown efficacy in decreasing sleep latency, significant side effects have been associated with these medications [27][28][29][30][31][32]. These include addiction, respiratory depression, decreased quality of sleep, and significant withdrawal symptoms when these medications are discontinued [21,[33][34][35]. Furthermore, due to the increasing prevalence of obstructive sleep apnea, continuous positive airway pressure (CPAP) machines are more regularly prescribed [27].…”

Extending the Reach of Antimicrobial Stewardship to Pediatric Patients

“…Professional organizations, including the American Nursing Association and the CDC support the incorporation of nurses in antimicrobial stewardship [23]. This is especially important in pediatrics because nurses best understand the impact of antimicrobial use on the day-to-day lives of hospitalized children, where minimizing discomfort and maintaining schedules for feeding and sleep are so important [24]. For example, administering an oral antibiotic to a 3-year-old is not always easy, repeated blood draws create Overall, we observe that the handshake stewardship approach, in collaboration with decentral pharmacists and bedside nurses, works well in pediatric stewardship.…”

Family Education Optimization from the Perspective of Complex Discrete Computational Thinking

“…Computational thinking is an important skill that guides individuals in the twenty-first century in solving problems in everyday life, and it is crucial to develop computational thinking from the early school years [12]. roughout the presentation, the development of computational thinking assessment is mainly reflected in three aspects: the definition of the level of developmental criteria, the proposal, and the practical application of assessment instruments.…”