When's the last time you got a good night's sleep?
There are always excuses for why we didn't get our recommended eight hours of sleep: The game ran late. I couldn't put my book down. My child had a nightmare. My husband was snoring.
For most of us, missing a few hours of sleep means that we're just a bit grumpier in the morning, but a strong cup of coffee will usually get us back to our usual selves.
For those in the hospital--particularly the ICU--sleep is crucial, and an article in USA Today this week tells us that being a patient in the ICU isn't particularly restful.
ICU patients--because of their conditions--are checked on and visited by nurses and other hospital staff members much more often than those in regular hospital units. They're hooked up to machines that have alarms and beep to notify caregivers when they're not working properly, or have to be reset. Many ICU patients are on pain controlling drugs like morphine that make it hard to sleep, the article says.
The result is patients drifting in and out of sleep--not reaching the deep levels of sleep that promote healing--says, "Quantity and Quality of Sleep in the Surgical Intensive Care Unit: Are Our Patients Sleeping?" published in the December 2007 issue of The Journal of Trauma: Injury, Infection and Critical Care.
The study was led by Randall Friese, MD, of the University of Texas Southwestern Medical Center. It studied the sleep patterns of 16 intensive care patients at Parkland Memorial Hospital in Dallas. It suggests that hospitals examine their intensive care units and assess whether providing patients with more comfortable, home-like rooms, removing unnecessary medical equipment and adjusting light levels will help patients get more of the restful sleep they need to recover.
As we get ready for HCAHPS, a quiet hospital atmosphere is a topic that many have tried to tackle. Many hospitals have engaged nurses and other caregivers in efforts to keep hallways quiet and limited the number of overhead pages that happen during the nighttime hours. But have you considered those necessary interruptions--the medication-giving, blood-pressure taking visits--could be preventing them from getting the good, deep sleep they need to heal?
As Quality Leaders, we should be thinking about how much good sleep our patients are getting--whether it be in the intensive care unit or otherwise. We know that it is in our organization's best interest to get patients well in as little time as possible--keeping costs low and quickening the turnaround of hospital beds.
Going back to HCAHPS, we also want to make sure that our patients are answering the survey in the best frame of mind. Remember that grumpy feeling I mentioned earlier? If a patient leaves your hospital feeling sleep deprived and not quite healed, it's likely they'll remember that when they record their impressions of your hospital--particularly when the survey asks about the area surrounding the patient's room being quiet at night.
Good, quality sleep is important for all of us--but particularly so for those recovering from an illness and trying to heal. What does your hospital do to ensure a healing environment for its patients? I'd love to hear about it.
The Maine Hospital Association recently announced a voluntary statewide initiative aimed at preventing patients and insurance companies from getting billed for the expense of medical errors that lead to longer hospital stays. But a state lawmaker says the voluntary policy doesn't go far enough and is pushing for an enforceable law that would make it illegal to charge patients or other payers for medical missteps that should never have happened in the first place.
A technician mistakes an "A" for an "O" in a drug name. A doctor misplaces a decimal point in a prescription order. A nurse reaches for a vial in a cabinet as she's done hundreds of times before, only this time the light is dim and she fails to notice that the powder-blue label is more of a sky blue. The slip-ups are often simple, and always human, and all have happened in U.S. hospitals. Each simple mistake is supposed to be countered by a recommended backup, a second or third set of eyes--in other words, guidelines to reduce human error. A lot has to be overlooked in the cascade of errors that result in serious patient harm.
Premier Healthcare, an alliance of non-profit hospitals and purchasing network, announced that Pay for Performance initiatives are not only improving quality at hospitals, but also driving costs and mortality rates down. The report says that 70,000 lives could be saved nationwide if all hospitals were to achieve the three-year cost and quality improvements found at the 250 hospitals that participated in the analysis.
As part of a new national program, Medicare has named five hospitals in South Florida as targets for quality improvement. The hospitals are being measured for surgical care improvements. Four of the hospitals were targets for improvement for only one measure: Not doing enough to end the use of preventative antibiotics within 24 hours after surgery.
For those afflicted with dementia, whether through Alzheimer's disease or other underlying cause, the presence of a "best friend" can make a huge difference in continued quality of life. Avamere Health Services in Oregon has adopted the 'Best Friends' program to encourage Avamere staff members to be patient advocates and caregivers. Staff receive six hours training based upon the methodology of Alzheimer's care developed in the 1990s by David Troxel and Virginia Bell. Caregivers learn to familiarize themselves with the life stories of these patient-partners, to respect and indulge their preferences and encourage remaining capabilities, no matter how limited. The approach leads to fewer conflicts, and residents, in turn, feel safe and valued.