By Lizzie Healey
An initiative to improve the quality and depth of sleep for patients in the Surgical High Dependency Unit (SHDU) at Glasgow Royal Infirmary (GRI) has seen remarkable outcomes since its introduction last year.
The ‘Sleep Well, Feel Well, Get Well’ initiative was the brain child of one of the nurses in the unit after she experienced a period of time as a hospital patient.
Sleep is a necessity that allows the brain and the body to repair and rejuvenate. However, sleep disturbance is a significant issue for patients in a critical care setting.
Shona McKie is a staff nurse in GRI’s SHDU. Following a sudden severe illness she was an inpatient in a High Dependency Unit and realised that sleep deprivation was having a negative impact on her recovery.
Shona wanted to look at how her place of work was performing and started collecting data from patients on what disturbed their sleep when in the unit.
The data showed that simple things like bin placement, doors banging and the noise of alarms and machinery were amongst the highest factors for broken sleep, alongside the frequency of nursing interventions.
Shona said: “After my experience I had a bee in my bonnet about making simple changes that would enhance the sleep of patients in the unit”.
“The physiological and psychological consequences of lack of sleep are significant and can result in the patient being agitated, their reaction time slower and their tolerance to pain lower.
“When I started I wanted to find out from the patients about their sleep experience in the unit and it was a surprise that the biggest percentage of sleep disturbance was the frequent coming and going of the nursing and medical staff. Other noises described by the patients as either keeping them awake or waking them during sleep was also an eye opener.
“One patient described how a flapping sound awoke them on a regular basis. At first I could not identify what that might be but eventually I realised that the noise was when the nursing staff were putting on the protective aprons and flapping them to open them up.”
Shona took the information provided by the patients and after meeting with other nursing staff implemented a ‘sleep bundle’ to include sleep as an essential component in each patient’s recovery, alongside other therapies like physiotherapy and food, fluid and nutrition.
Shona slowly began to implement small changes both with the staff routines in the unit and the environment. Simple changes included adjusting the volumes on alarms and equipment, introducing individual rest times for each patient where their room lights are dimmed and blinds or curtains closed, their door closed and entrance to their rooms is kept to an absolute minimum and ear plugs and eye masks provided.
Shona added: “Making these small changes has taken a lot of adjustments to the way the staff work but my colleagues, both nursing and medical, have embraced these and the difference this has made to the patients is really positive.
“We are also offering patients relaxation tips which they can use just before their individual rest times and the staff play active roles in sleep promotion in the unit.
“We have had feedback from patients and their families with one patient saying ‘thank you for the relaxation tips – I’ve had the best night’s sleep since coming into hospital’, and a wife said on her husband ‘after his good night’s sleep my husband feels ready for the busy day ahead – he is aiming for 4 walks today’.
“Staff have also given their feedback on the changes including ‘the improvement plan was easy to implement. Simple changes that make a big difference to patients’ from one of the staff nurses.
“I have had other units from across both NHSGGC and Scotland approach me for information on the initiative which hopefully they can implement locally.
“I was also recently delighted to have been a winner of the Quality Care award at this year’s national NHSScotland event. This award recognises individual work which puts patients at the heart of their care and this is exactly what this initiative is about.”