789: IMPACT OF A PHARMACIST-DRIVEN SLEEP-PROMOTING PROTOCOL ON DELIRIUM IN THE CRITICALLY ILL

Abstract

Introduction: Sleep deprivation is reported in nearly 80% of patients in the intensive care unit (ICU) and is associated with delirium. Guidelines recommend implementing a multicomponent sleep-promoting protocol in critically ill patients. ICU sleep protocols may increase the quantity and quality of sleep and may decrease delirium. Our objective was to develop and implement a pharmacist-led interdisciplinary sleep-promoting protocol and analyze its impact on delirium in intubated and non-intubated ICU patients. Methods: The study involved pre-implementation education and protocol development, and post-implementation analysis. ICU pharmacists completed prospective patient chart reviews to reduce exposure to deliriogenic medications and assess the patient’s need for a pharmacological sleep aid. The primary outcome was to assess the difference in the incidence of delirium and delirium-free days pre- and post-implementation. Secondary outcomes included ICU length of stay, incidence and duration of mechanical ventilation (MV), documented pharmacist medication interventions, and patients receiving a pharmacologic sleep agent (%), Results: Post-protocol patients (n=185) had a higher incidence of delirium compared to pre-protocol patients (n=237) (51.3% vs 39.0%; p=0.01). Post-protocol patients had a higher average APACHE III score (p=< 0.001). Delirium-free days were not significantly different between groups (p=0.97). Difference in ICU length of stay was not significant (p=0.80). More patients received MV post-protocol implementation (55.7% vs 36.1%; p< 0.001). MV days were similar between groups (p=0.053). Pharmacists documented a total of 113 medication interventions. Half of the study patients did not receive an insomnia agent during their ICU admission. Conclusions: A pharmacist-led, ICU sleep-promoting protocol was successfully implemented at our institution. The protocol did not reduce the incidence of delirium or the administration of insomnia agents in our ICUs. Post-protocol patients had a higher disease severity and were more likely to receive mechanical ventilation which may have impacted our results. The incidence of delirium in our patients was consistent with the national reported prevalence of ICU delirium. ICU pharmacists on all shifts had an active role in optimizing sleep in the critically ill.