Utilization of the "Do Not Disturb” Order to Improve Sleep Quality in the Medical-Surgical Patient

Sleep disturbances in the hospital setting can lead to decreased patient outcomes and place geriatric patients at risk for developing delirium. This organization implemented a quality improvement project to improve sleep quality for the medical- surgical patients in an academic Magnet hospital. Nurse residents developed an evidence-based practice project (EBPP) designed to investigate interventions to improve sleep quality in this patient population.

Evidence reveals that patients are often woken for vital sign checks to comply with the modified early warning system (MEWS) protocol, even though they often score as a low risk for deterioration on the scale. Nurse residents noted that our facility’s electronic health record had a “do-not- disturb” patient from 2300-0500 order available; however, it was rarely utilized by providers.

The nurse residents met with the geriatric trauma multidisciplinary council and the trauma performance improvement and patient safety (TPIPS) council to review the literature findings and prompt utilization of the do-not-disturb order. Pre-implementation, a retrospective chart audit including 50 patient charts was conducted to investigate the patient population that would meet the criteria for this order placement. The established criteria included patients with a MEWS score less than 2 in the past 24 hours, no operative procedures with the past 24 hours, no falls within the past 24 hours, no change in level of consciousness within the past 24 hours, no transfer from intensive care or new inpatient admission within the past 24 hours, and no patients CAM positive within the past 24 hours. Education for the nursing and physician providers was developed on the do-not-disturb order for eligible patients

The retrospective chart audit results determined that 85% of the patients included in the audit would meet the criteria to have the do-not-disturb order placed. Nine patients in the project were able to have their sleep undisturbed during the implementation period. This EBPP prompted an awareness of sleep quality and health for our geriatric population and the potential strategies that could benefit this patient population. Since the project, there has been an increase in use of this order for our geriatric population as a means to decrease delirium in the hospital setting. Future steps include project implementation on a larger scale with policy revisions for the MEWS scale.