Quality improvement initiative aims to significantly reduce highly fragmented sleep with frequent arousals to improve recovery for children in the hospital.

While the National Sleep Foundation recommends that school-aged children need nine to 11 hours of sleep each night, studies show many get only seven to eight hours per night — and that’s at home. In the hospital, where sleep is important to recovery from an acute illness or injury, young patients face frequent arousals thanks to environmental noise from overhead pagers, intravenous pumps and alarms, not to mention middle-of-the-night blood draws and vital signs checks. The consequences?

“We know not sleeping well affects your overall well-being, and of particular concern to us is that it may slow your healing in the hospital,” says pediatric pulmonologist Laura Sterni, a sleep specialist at Johns Hopkins Children’s Center. “While healthy sleep is associated with an improved ability to fight infection and enhanced vaccination responses, research shows sleep deprivation leads to problems such as mood disturbances, worsening sensations of pain, and has significant negative effects on the immune system.”

To help avoid such outcomes for young patients, Sterni and pediatric nurse Elizabeth Harkins applied for and received a Johns Hopkins Department of Pediatrics Innovation Grant for a program designed to facilitate healthy and healing sleep in the hospital. Aptly named SHHH (Sleep Health and Hindrances in Hospitals), the initiative uses sleep-promoting strategies solicited from a group of nurses, pediatric residents, respiratory therapists, pharmacists, psychologists and parents — what Sterni refers to as a sort of multidisciplinary dream team.

Among the ideas is sleep-promoting signage in patient rooms, serving as prompts for service teams to ask about sleep and enact changes to encourage it. Door tags alert providers when young patients are sleeping, and a “sleep menu” allows patients and their families to request white noise machines, an extra pillow, eye masks, herbal tea, lip balm and bedtime books. Nursing units now include sleep education binders for the staff to brush up on the importance of sleep for patients’ health.

In addition, clinical staff during morning rounds survey patients and families about nighttime disruptions. Pediatric hospitalist Lauren McDaniel has been working with the Armstrong Institute for Patient Safety and Quality at Johns Hopkins to reduce those disruptions through finding ways to modify orders in the electronic patient record system and on the floor to help residents consider limiting nighttime vitals when safe, and to avoid nonessential medications and procedures during preferred sleeping hours.

“Do we really need that blood pressure reading at 2 a.m.,” says Sterni. “There are definitely interruptions that occur in the hospital over night that are unavoidable, but there are plenty that could be avoidable and would help us improve sleep.”

Sterni and the team will be tracking results of the initiative over the next several months. Sleep tight!