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THE EMPOWERED NURSE

Jillian Lange, BSN, RN-BC
Increasing Sleep Quality in 60 minutes
Clinical Nurse, Partially Hospitalized Adults,
Vanderbilt Behavioral Health
Purpose: Insomnia affects a large portion of the psychiatric
patient population. Evidence supports the use of Cognitive Behav-
Other contributing authors: William Ross, BSN, RN, Jessica Lauren
ioral Therapy for Insomnia (CBT-I) as a first-line therapy for Webb, LCSW, Arlene Thomas, Jillian Lange, BSN, RN-BC, Elizabeth
chronic insomnia. While CBT-I has shown to be an effective inter- Card, MSN, APRN, FNP-BC, CPAN, CCRP, FASPAN

vention for insomnia, CBT-I is underutilized in inpatient settings.

Relevance/Significance: The study utilized the Pittsburgh Promoting Safer and More Efficient Medica-
Sleep Quality Index to examine the sleep of patients admitted to tion Administration within the Accident and
a psychiatric Adult Partial Hospitalization Program (PHP) after
receiving an abbreviated 60-minute CBT-I group intervention. Emergency Department at Georgetown
Originally, CBT-I was designed as a six-week program. Lit- public Hospital Corporation, (GPHC),
erature suggests the effectiveness of abbreviated CBT-I, which
has shown to be cost and time effective and may address treat- Guyana
ment barriers for insomnia and sleep related issues. This study
contributes to the available information and literature on the fea- Objective: The Emergency Department is a complex envi-
sibility of abbreviated CBT-I. ronment in which health care providers are confronted with un-
controlled and unpredictable critical patient workload. This
Strategy and Implementation: On their second day of ad- necessitates multitasking, organization, critical thinking and
mission to the PHP program, a CBT-I trained nurse invited pa- clear communication. Safe practices during dispensing and ad-
tients to participate in the IRB approved study. At the time of ministration of medications vastly reduce the potential for pa-
consent, participants completed the initial Pittsburgh Sleep tient harm and decreases medication errors (Institute for Health
Quality Index (PSQI). During their time in PHP, participants re- care Improvement, 2008).
ceived a 60-minute abbreviated CBT-I (aCBT-I) group interven-
tion. The group covered core CBT-I topics, including the Design/Methods: An eight-question survey was developed
physiology of sleep; circadian rhythm and the impact of sunlight to determine nurses’ perceptions of the current medication stor-
and darkness on melatonin; body temperature circadian rhythm age system. Participants were asked to identify ways in which
and its impact on sleep; Negative Sleep Thoughts and their ad- this system could be improved and medications organized in a
verse effect on sleep and cognitive restructuring; stimulus-con- safer, more systematic way. Following initial data collection, all
trol techniques used to establish the bed as a place for sleep only; medications were rearranged to improve medication organiza-
and lifestyle and environmental factors that affect sleep. An e- tion and retrieval. The participants were then surveyed following
mail was sent one month post initial PSQI survey inviting the the intervention to ascertain feedback.
participants to complete the post-intervention PSQI survey.
Results: Sixty-eight percent of participants noted that they
Evaluation/Outcomes : A total of 42 subjects consented, perceived the current system to be chaotic. When asked if organi-
21 completed the project. Analysis of PSQI results pre to post in- zational changes might improve patient care delivery and safety,
tervention revealed a statistically significant increase in the qual- 96% responded in the affirmative. Labeling medication with both
ity of sleep (p.005). Sleep latency decreased from a median of 45 generic/brand names and organizing them by class and alphabeti-
to 35 minutes, sleep time increased from a median 6 to 7. cally thereafter were all identified as potential options for reorgani-
zation. Following the intervention, a post-survey demonstrated
Implications for Practice: Patients can learn to improve that 100% of respondents remained enthusiastic about the new
sleep quality in the hospital setting and apply concepts at home system approximately nine months after implementation.
post discharge. Nurses teaching a CBT-I during a single 60-
minute session is feasible. Nurses can successfully educate pa- Conclusions: The previous medication storage system was
tients in group settings to successfully improve their sleep. CBT-I fractured and chaotic. Systematic organization of medications
is a potential intervention for use in other inpatient settings. by name/class improved nurses’ perceptions of medication
safety and delivery while inadvertently reducing the waste of ex-