Christine L Mozer1, Palak H Bhagat2, Sarah A Seward3, Noah R Mason1, Samantha L Anderson4, Maxx Byron4, Leah B Peirce5, Victoria Konold6, Madan Kumar1,7, Vineet M Arora1,4, Nicola M Orlov8,9. 1. Pritzker School of Medicine, The University of Chicago, Chicago, Illinois. 2. Department of Pharmacy and. 3. IS Technology and Applications, Children's Wisconsin, West Allis, Wisconsin. 4. Section of General Internal Medicine, Department of Medicine. 5. Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; and. 6. Infectious Diseases and Virology, Seattle Children's Hospital, Seattle, Washington. 7. Sections of Infectious Diseases and. 8. Pritzker School of Medicine, The University of Chicago, Chicago, Illinois; nmeyerorlov@peds.bsd.uchicago.edu. 9. Pediatric Hospital Medicine, Department of Pediatrics and.
Abstract
OBJECTIVES: Hospitalized children experience frequent nighttime awakenings. Oral medications are commonly administered around the clock despite the comparable efficacy of daytime administration schedules, which promote sleep. With this study, we evaluated the effectiveness of a quality improvement initiative to increase the proportion of sleep-friendly antibiotic administration schedules. METHODS: Interprofessional stakeholders modified computerized provider order entry defaults for 4 oral antibiotic medications, from around the clock to administration occurring exclusively during waking hours. Additionally, care-team members received targeted education. Outcome measures included the proportion of sleep-friendly administration schedules and patient caregiver-reported disruptions to sleep. Pre- and posteducation surveys were used to evaluate education effectiveness. Balancing measures were missed antibiotic doses and related escalations of care. RESULTS: Interrupted time series analysis revealed a 72% increase (interceptpre: 18%; interceptpost: 90%; 95% confidence interval: 65%-79%; P < .001) in intercept for percentage of orders with sleep-friendly administration schedules (orders: n pre = 1014 and n post = 649). Compared with preeducation surveys, care-team members posteducation were more likely to agree that oral medications scheduled around the clock cause sleep disruption (resident: 71% pre, 90% post [P = .01]; nurse: 63% pre, 79% post [P = .03]). Although sleep-friendly orders increased, patient caregivers reported an increase in sleep disruption due to medications (pre 28%, post 46%; P < .001). CONCLUSIONS: A simple, low-cost intervention of computerized provider order entry default modifications and education can increase the proportion of sleep-friendly oral antibiotic administration schedules for hospitalized children. Patient perception of sleep is impacted by multiple factors and often does not align with objective data. An increased focus on improving sleep during hospitalization may result in heightened awareness of disruptions.
OBJECTIVES: Hospitalized children experience frequent nighttime awakenings. Oral medications are commonly administered around the clock despite the comparable efficacy of daytime administration schedules, which promote sleep. With this study, we evaluated the effectiveness of a quality improvement initiative to increase the proportion of sleep-friendly antibiotic administration schedules. METHODS: Interprofessional stakeholders modified computerized provider order entry defaults for 4 oral antibiotic medications, from around the clock to administration occurring exclusively during waking hours. Additionally, care-team members received targeted education. Outcome measures included the proportion of sleep-friendly administration schedules and patient caregiver-reported disruptions to sleep. Pre- and posteducation surveys were used to evaluate education effectiveness. Balancing measures were missed antibiotic doses and related escalations of care. RESULTS: Interrupted time series analysis revealed a 72% increase (interceptpre: 18%; interceptpost: 90%; 95% confidence interval: 65%-79%; P < .001) in intercept for percentage of orders with sleep-friendly administration schedules (orders: n pre = 1014 and n post = 649). Compared with preeducation surveys, care-team members posteducation were more likely to agree that oral medications scheduled around the clock cause sleep disruption (resident: 71% pre, 90% post [P = .01]; nurse: 63% pre, 79% post [P = .03]). Although sleep-friendly orders increased, patient caregivers reported an increase in sleep disruption due to medications (pre 28%, post 46%; P < .001). CONCLUSIONS: A simple, low-cost intervention of computerized provider order entry default modifications and education can increase the proportion of sleep-friendly oral antibiotic administration schedules for hospitalized children. Patient perception of sleep is impacted by multiple factors and often does not align with objective data. An increased focus on improving sleep during hospitalization may result in heightened awareness of disruptions.
Authors: Mitchell Kim; Stephen J Kaplan; Steven H Mitchell; Medley Gatewood; Itay Bentov; Katherine A Bennett; Carol A Crawford; Paul R Sutton; Diane Matsuwaka; Mamatha Damodarasamy; May J Reed Journal: Drugs Aging Date: 2017-10 Impact factor: 3.923
Authors: Mila N Grossman; Samantha L Anderson; Aelaf Worku; William Marsack; Nimit Desai; Ambrosio Tuvilleja; Jacqueline Ramos; Mary Ann Francisco; Cynthia Lafond; Jay S Balachandran; Babak Mokhlesi; Jeanne M Farnan; David O Meltzer; Vineet M Arora Journal: J Clin Sleep Med Date: 2017-02-15 Impact factor: 4.062
Authors: Leah B Peirce; Nicola M Orlov; Amarachi I Erondu; Samantha L Anderson; Michael Chamberlain; David Gozal; Vineet M Arora Journal: J Clin Sleep Med Date: 2018-11-15 Impact factor: 4.062