Improving Sleep in the Neurology In-Patient Population

Study Overview
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Brief Summary
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We aim to test multiple interventions to improve sleep for Neurology inpatients, including 1) a sleep-friendly order set, and 2) a sleep menu. We will collect patient sleep data, including duration and quality, via actigraphy devices (FitBits). We will also conduct qualitative patient surveys to understand the impact of these interventions.

Official Title
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Improving Sleep in the Neurology In-Patient Population

Conditions
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Sleep

Intervention / Treatment
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* Other: Sleep friendly order set
* Other: Patient sleep menu


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age ≥ 18 24 hours after admission to the general neurology (ward) service at the Hospital of the University of Pennsylvania Patients who are determined by the primary team to be clinically stable enough to forego serial overnight vital signs monitoring and neuro checks. Clinical stability criteria: Symptomatic stability >24h after admission (no new or progressive neurologic symptoms for >24 hours) Vital signs stability on admission for > 24h while admitted Ability to verbally consent to study participation Exclusion Criteria: Any medical or psychological conditions that, in the opinion of the investigator, would compromise the subject's safety or successful participation in the study. Any additional clinical factors felt by the team to be incompatible with specific orders including requiring serial vital signs monitoring and neuro checks overnight

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Non-Randomized
Intervention Model: Sequential Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Standard of care<br> | |
| Experimental: Sleep intervention<br> | Other: Sleep friendly order set<br>* Every evening, the following orders (which comprise the sleep-friendly order set) will be input into the EMR: Hold vital signs and neurological checks overnight Retime applicable medications outside of the nighttime window of 10pm-6am Retime daily lab draws outside of the nighttime window of 10pm-6am Order melatonin if no clinical contraindications Discontinue finger stick glucose measurements for patients with a stable blood glucose values Change DVT prophylaxis to enoxaparin for all clinically eligible patients<br>Other: Patient sleep menu<br>* Patients will be given a menu of non-pharmacological options that support sleep by improving comfort and reducing anxiety.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Fitbit Sleep Duration | Total hours of sleep | Duration of hospitalization from consent to discharge or day 10, whichever comes first | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| FitBit sleep score | The sleep score integrates subject sleep deprivation, sleep depth, and sleep restoration | Duration of hospitalization from consent to discharge or day 10, whichever comes first | 
| Richard Campbell Sleep Questionnaire (RCSQ) | The Richards-Campbell Sleep Questionnaire (RCSQ) is a simple, validated survey instrument for measuring sleep quality in intensive care patients | Duration of hospitalization from consent to discharge or day 10, whichever comes first | 
| Patient reported Sleep Duration and Quality | A brief survey collecting patient perceived duration and quality of sleep | Duration of hospitalization from consent to discharge or day 10, whichever comes first |