Survey of clinical pharmacist perceptions and practices in promoting sleep in intensive care unit patients

Abstract

ObjectivesSleep deprivation is associated with significant patient morbidity in the intensive care unit (ICU) and must be addressed through a systematic, interdisciplinary approach. The objectives of this study were to describe pharmacists' perceptions and practices regarding sleep in the ICU. We also assessed the prevalence and characteristics of systematic processes to promote sleep in ICU patients.MethodsWe administered an international, cross‐sectional survey to 1723 pharmacists via a member distribution list through the American College of Clinical Pharmacy Critical Care Practice and Research Network. The survey included questions about pharmacists' demographics, practice sites, and individual and site‐specific perceptions of sleep promotion practices.ResultsTwo hundred fifty‐five (15%) pharmacists initiated the survey and 195 were completed and included for analysis. Respondents most commonly had less than 5 years of experience in ICU practice, completed a Critical Care Pharmacy Residency, and worked in a Medical or Surgical ICU. All participants responded that the assessment of sleep quality is important in the ICU. Most respondents reported that they recommend both non‐pharmacological (81%) and pharmacological (93%) interventions to optimize sleep in their ICU patients. Pharmacists reported most commonly recommending to adjust non‐sleep‐related medications to avoid nighttime administration (41.4%) and initiating melatonin receptor agonists (33.7%). A low number of respondents (9%) reported the presence of a sleep protocol in their ICU. Within this subset, 59% reported that less than half of their ICU patients actually receive the protocol and 41% indicated low protocol compliance.ConclusionsCritical care pharmacists value sleep, and most recommend interventions to optimize sleep in their patients. However, sleep protocols in ICUs are uncommon, and overall protocol use and compliance are perceived to be low. Pharmacists can improve protocol use and compliance and potentially impact sleep, delirium incidence, or other ICU patient outcomes. This impact should be evaluated in future studies.