An official American thoracic society statement: position statement on ATS activities for the promotion of respiratory and sleep/wake health and the care of the critically ill in the United States

The development of a clinical practice guideline to improve sleep in intensive care patients: a solution focused approach

OBJECTIVE

Our objective was to develop a guideline to improve the opportunity for intensive care patients to rest and sleep.

DESIGN AND SETTING

A pragmatic solution focused approach to guideline development and implementation was used in which data from international literature and original research from the study ICU were appraised in extensive consultation with intensive care staff. Audits were conducted early in the implementation phase to measure adoption rates.

RESULTS

Over 320 suggestions were made for inclusion in a practice guideline. Information was integrated to create the guideline. A comprehensive 'rest and sleep for the intensive care patient' guideline was developed comprising two main themes: 'Optimise the environment' (for example, 'Quiet conversation') and 'Rest and sleep interventions' (for example, 'Provide optimal conditions for night-time sleep'). Audit data suggested that adoption of the guideline had begun but was not yet embedded in practice.

CONCLUSION

The solution focused approach to addressing improvements ICU patients' sleep and the consideration of multiple sources of evidence resulted in the development of a comprehensive, context specific guideline. The process, based on a solution focus, may overcome difficulties faced by clinicians endeavouring to improve health care when there is a lack of high level evidence.