Improving Inpatient Sleep in orthogeriatric patients - Quality Improvement Project

Background:
In orthogeriatric patients, sleep quality is often overlooked despite its association with pain, mobility, and rehabilitation outcomes. This project assessed inpatient sleep quality on Elm Ward at Trafford General Hospital and evaluated interventions to improve sleep.

Aim:
To assess inpatient sleep quality and implement non-pharmacological and pharmacological interventions.

Methodology:
Baseline sleep quality data were collected from eligible inpatients using a sleep questionnaire prior to two Plan–Do–Study–Act (PDSA) cycles. The first cycle introduced non-pharmacological interventions, while the second introduced melatonin for suitable patients. Two SMART aims were defined: weekly sleep screening for all inpatients and for a two-point improvement in average sleep quality scores (10-point scale) by 21 December 2025.

Results:
At baseline, 32% of patients were screened weekly, with a mean sleep quality score of 6.70/10. During the first cycle, ten randomly selected patients were assessed weekly following non-pharmacological interventions, including sleep masks, earplugs, and staff education. Screening rates increased to 90%, with a modest improvement in mean sleep quality to 6.95/10. During the second cycle, ten randomly selected patients were again assessed weekly following the introduction of melatonin to those that were clinically appropriate. Screening rates did not further increase and saw a sharp decline in the final two weeks. Mean sleep quality increased slightly to 7.03/10, while the median score remained unchanged at 7/10. Secondary outcomes, including sleep interruptions and morning restfulness, showed modest and inconsistent improvement across cycles. Despite this, neither SMART aim was achieved.

Conclusion:
Improving inpatient sleep quality in an orthogeriatric setting is challenging. Although screening practices can improve in the short term, sustained improvements were not achieved due to patient complexity, ward environment, staffing pressures, and other non-modifiable factors. Future initiatives should prioritise targeted interventions for patients with poor sleep and embed sleep assessment into routine ward practice.