CALTCM has partnered with CAHF to address common care processes that may interfere with our patient’s sleep preferences.  The focus of the CAHF Quality Subcommittee’s initiative has been the timing of medications and administration of beverages (see attachments below).  These model policies and procedures provide a flexible and safe way to modify incoming orders, including medication orders and timing, for both new admissions and also serve as a tool for adjusting these care plans for long-stay residents.  

In addition to the interventions above, we know that there are many other facility factors that may interfere with sleep that may be modified.  To begin, practitioners and the IDT should ask these questions for every resident: 

Resident Orders: Coordinating resident care

• Do vital signs, such as 02 sats and finger stick glucose checks, need to be performed between 11 p.m. and 7 a.m.?  
• Can medication administration times, including nebulizers, be safely adjusted to avoid waking a sleeping resident during bedtime?
• Do all residents who require assistance with bed mobility need to be turned and repositioned every two hours, all night long?
• Can high absorbency briefs be used at bedtime to reduce the number, and frequency of incontinence checks?

Resident Activities: Proactive steps to foster a good night of sleep

• If a resident is consistently disturbing the peace at night, have the potential root causes for those behaviors been identified?
• Can more precise and effective interventions be identified?
• Are clinicians with problem behavior expertise available to help your IDT?
• Is 20+ minutes of outdoor morning sunlight a part of the day for most residents to help set their biological clocks for sleep?
• Is daily exercise an option for most of your residents?
• For all night TV watchers, are wireless headsets and curtains that reduce white light from TV’s available?
• Do you discourage watching TV programs in the evening like violent programs or the “News,” knowing that this is not the time to activate the mind with upsetting information?  

Environmental Factors: Improving the resident’s experience

• Are white noise machines an option to reduce noise from roommates and/or staff? 
• Is aromatherapy, such as lavender oil or cream, available for residents who might find it relaxing?
• Have you minimized bed, chair, and other kinds of alarms?
• Are fans available to move air that might become stale overnight?
• Do you have options for relaxing music available at the bedside in the evening?

IDT Changes

• Have you minimized the noise of locating staff at night for resident services?
• Is your frontline staff using headlamps or flashlights when providing room service during hours of sleep?
• Has your frontline staff been instructed not to converse and laugh loudly, and to be mindful of other noisy or disruptive sounds and activities?

We realize the above list may be incomplete and welcome responses from our readers who have had success protecting sleep in their facilities.  Please provide your feedback in our blog below. If you are not a CALTCM member and would like to contribute to our blog, simply contact our office at (888) 332-3299 for a complimentary account.

Protecting sleep will not be easy, but it will be easier if we work together. The literature supports the value of a good night of sleep for reducing the risk of delirium and for improving the quality of life of our residents and their ability to participate in healthy daytime activities.  

This initiative will require an interdisciplinary QAPI approach.  Please share this article with your management team for their review and response.

The Clinical Practice Workgroup at CALTCM

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• Sleep Hydration Policy
• Person-Centered Medication Administration