An Evaluation of a Pharmacist-Driven Sleep Promotion Program

Objectives: Sleep in the hospital is often disrupted by modifiable factors. When addressing poor sleep in the hospital, non-pharmacologic strategies should be utilized initially; however, pharmacologic therapies are often prescribed first. The objective of this initiative was to determine if pharmacist-led initiation of a sleep promotion order set improved quality of inpatient sleep. Methods: This was a prospective, single-center, before-and-after quality improvement project. Patients admitted to the adult internal medicine service with a pharmacologic sleep aid ordered were considered for inclusion. Pharmacists conducted baseline sleep assessments using the Modified Richards Campbell Sleep Questionnaire (mRCSQ), then recommended initiation of the sleep promotion order set. A second mRCSQ was conducted 2 to 5 nights after order set initiation. The mean difference in mRCSQ for individual patients before and after sleep promotion were compared. Results: Fifty-three patients completed both baseline and follow-up mRCSQ surveys. The average mRCSQ score before sleep promotion was 55.8 and the average score after sleep promotion was 56.8 with a subject paired difference of 1.0; P = .8. Individual components of the mRCSQ survey were compared and not found to have significant differences. Conclusions: Implementation of the sleep promotion order set did not result in a significant improvement in patient-reported sleep. This study was marked by significant limitations including difficulty with patient comprehension of the mRCSQ sleep assessment tool, lack of assessment of adherence to the order set, and variability in where in patient clinical course sleep assessments were performed. Despite the findings of this project, further evaluation should be made into the ideal sleep assessment tool for an internal medicine patient population. Medical teams should continue to make an interdisciplinary effort to address modifiable risk factors to optimize sleep in the hospital and limit prescribing of pharmacologic sleep aids.