CALTCM Partners With CAHF and Others To Improve Residents' Sleep
by Karl Steinberg, MD, CMD, HMDC
President-Elect, CALTCM
Chief Medical Officer, Mariner Health Care

Everyone knows the importance of good, restorative sleep, no matter what kind of physical health a person is in. It's even more important for frail elders and post-acute patients recuperating from a hospitalization from surgery or illness. To that end, CALTCM has been collaborating with the California Association of Health Facilities (CAHF)'s Quality Subcommittee, Diagnostic Laboratories (Schryver), Empira and others to promote some specific initiatives that will impact our residents' sleep in a very positive way.

Among the concrete, practical strategies being suggested in the Protect Sleep Initiative are changes in lighting, which are highlighted in this piece from the CAHF News site, featuring ACC Care Center in Sacramento

Other recommendations will be to create policies and procedures that allow for flexibility, in appropriate residents, as to overnight turning and repositioning regmens--usually done every two hours as a default--since there is little empiric evidence to support superiority of every-two-hours versus every-four-hours regimens in preventing skin breakdown.  Also, facilities will be encouraged to implement policies to request changes in medication, tube-feeding and finger-stick blood sugar monitoring regimens--when medically appropriate--to avoid awakening residents for such interventions.  For example, many residents are admitted from the hospital with orders for every-six-hour nebulizer treatments, which result in a "Hey, it's midnight, wake up and take your adrenaline-like bronchodilator," followed by a "Hey, wake up again, it's 6 a.m., time for another one!" type pattern that is quite disruptive and often not medically necessary.  Finally, some laboratory providers, notably Diagnostic Laboratories, are transitioning to evening-shift phlebotomy with next-morning reports for routine, non-fasting lab work.  This avoids the vampire phlebotomists having to traumatize our residents in the wee hours of the morning, and at least in my area (San Diego County) has been very well-received.  

For a little bit more information, here is a link from my article in Caring for the Ages on the same topic:

Any of the WAVE's readers who are interested in participating in this initiative, or who have other ideas for improving our nursing home residents' sleep, please contact me and we will get you plugged in! or on Twitter @karlsteinberg