Improving Sleep to Reduce Falls on a Frailty Ward
Abstract
Introduction
Sleep disruption is highly prevalent among hospitalised older adults living with frailty and is associated with delirium, reduced engagement with rehabilitation, increased falls risk and prolonged inpatient stay. Environmental noise, lighting and night-time care practices are key modifiable drivers of poor sleep but are often overlooked in acute hospital settings. This quality improvement (QI) project aimed to introduce a ward-level, multidisciplinary sleep-promotion programme and evaluate its impact on sleep quality and patient-centred outcomes on a specialist frailty ward.
Methods
A service improvement study was conducted on a 27-bed frailty ward. Using staff and patient feedback, a structured sleep-promotion programme was co-designed and implemented. Interventions focused on protecting overnight rest and included environmental noise reduction (soft-close bins, reduced call-bell volume, limited use of noisy overnight equipment), lighting optimisation (lights off at 22:00, on at 06:00, use of bedside lamps), door management to reduce corridor noise and clustering and rationalisation of overnight observations. Staff education supported consistent sleep-protective practice. To reinforce the intervention, routine provision of decaffeinated hot drinks was introduced ward-wide from May 2024. Sleep quality and disruption were measured using structured daily questionnaires completed by staff and inpatients. Secondary outcomes included inpatient and nocturnal falls. Mean ward length of stay (LOS) was reviewed descriptively and compared with two Older People’s Unit wards.
Results
Following implementation, staff-reported sleep disruption and patient-reported sleep quality demonstrated improvement. Inpatient and nocturnal falls reduced post-intervention. Mean LOS on the frailty ward remained consistently lower than comparator wards over the study period, although comparisons are descriptive and influenced by case-mix and operational variation.
Conclusions
A multidisciplinary, low-cost sleep-focused QI programme is feasible and sustainable within routine frailty ward care. Protecting overnight sleep through environmental modification and rationalised care delivery may enhance patient experience, reduce harm and support rehabilitation and hospital flow.
Comments
Interesting topic!
Well done on an interesting poster demonstrating your QIP.
Inpatient sleep is a very difficult topic to address when patients are in hospital as there are numerous factors that contribute to poor sleep in hospital! I find it very interesting that you chose to look into this and how it impacts an older adult's falls risk.
Thank you for sharing your work.
Interesting work!
Thank you very much for sharing your work and your poster.
I think sleep is a very interesting but difficult issue to address as often in hospital there are multiple reasons as to why patients' sleep is disturbed. I am intrigued as to what in the first place made you question if poor sleep was contributing to falls on the ward?
Best wishes,
Emily