Studies have shown that lack of sleep leads to a dramatic decline in a person’s ability to perform even simple tasks. Individuals who are sleep-deprived may experience drowsiness, irritability, lack of concentration and impaired performance. Furthermore, sleep deprivation compromises the immune system and persistent sleep deprivation can result in significant mood swings and erratic behavior.
Jefferson Community Health and Life – Gardenside Long Term Care is a 40-bed skilled nursing facility in Fairbury, Nebraska. The Gardenside team aimed to improve the sleep hygiene, health and safety of their residents while promoting a more home-like environment.
In early 2016, the Gardenside team attended a Learning Collaborative, hosted by Great Plains Quality Innovation Network. At this session, a presentation on the benefit of sleep vitality as a way to prevent falls was shared.
As a result of knowledge gained, the Gardenside team set out to improve resident-centered natural awakening in their home. The team identified the two primary reasons for falls are noise and fragmented sleep.
Every staff member and department was involved in the quality improvement effort. Multiple PDSA cycles were implemented in the following areas:
- individualizing sleep routines; residents were given an option of when to go to sleep and when they wished to wake in the morning and assessment for appropriate incontinent briefs to avoid necessity for bedding changes
- adjusting staff hours to promote resident sleep ; limited cleaning and laundry during night, less medications being given during the night, change in restorative hours
- open dining; altered & expanded breakfast times so residents can be served upon arrival
- medication pass; alter medication administration times; updated eMAR with new time codes
- resident activities; extended evening activities, choices in night activities
- sleep environment; eliminating audible personal alarms, decreasing noises throughout the night (such as carts in the halls and doors closing), new pillows, lighting decreased throughout hallways and common areas and use of flashlights to avoid having to turn on lights during the night
The Gardenside team outlined several elements of their success. First, it is imperative to partner with the pharmacy team to decrease and alter medication times to reduce the frequency of medication passes and avoid having to wake residents to dispense medications. It took considerable time for, the medication delivery system (i.e., cassettes, bubble packs) to be relabeled with the new administration times, allowing for ample to time to accomplish this is an important step.
Visiting with residents and their family members prior to implementing the natural awakening program is necessary. This conversation allows the resident to share his/her preferred sleep environment and whether they have a preference for their wake-up time.
The Gardenside team also adjusted the dining room schedule to adjust for residents having an expanded timeframe to eat breakfast.
As a result of this effort to facilitate natural awakening, the Gardenside has experienced a decrease in fall and infection rates. The Gardenside team presented their successes at the Nebraska Healthcare Quality Forum in May 2017. They have also had the chance to share their story with nursing homes through a number of educational sessions and have mentored homes who wish to implement natural awakening as a means to reduce falls.
To view the recording of the July 18, 2017 Resident-Centered Natural Awakening WebEx where Deb Sutton, Administrator, and Samantha Wurm, Charge Nurse and QAA Leader with Gardenside describe the program along with lessons learned and successes, click here.
To learn more about the importance of sleep maintenance and enhancing resident quality of life, view the June 8, 2017 Sleep Hygiene/Falls Part II WebEx featuring Sue Ann Guildermann, click here.