Sleep for hospital inpatients: Evaluation of the Implementation of routine sleep assessment and a sleep protocol

Implementation science interventions to encourage uptake by health professionals of the 'getting it right for sleep at night' guideline and routine sleep assessment to improve sleep for hospital inpatients. The 'getting it right for sleep at night' guideline (TAG NSW) is evidence-based containing all interventions which may help promote and maintain sleep for hospital patients including and not limited to environmental controls, behaviour change (sound reduction at night and light levels conducive to circadian rhythm), avoidance of new prescriptions of sedative and hypnotic medications, assessment of sleep quality, provision of eye masks and ear plugs, clustering care at night and prioritising sleep over non-essential care/treatments at night. The brief 5 point Likert sleep scale ('very good' to 'very poor') was validated using the Richards Campbell Sleep Questionnaire (https://onlinelibrary.wiley.com/doi/10.1111/jocn.16348) and will be further validated in the pre-implementation phase of the current study. This scale has a drop down field to select the relevant descriptor of sleep and is designed for any health care worker to use and takes approximately 2 minutes to administer via the electronic medical record. Clinicians will ask the patient "Please describe your sleep last night on a scale of 'very good to very poor' ". Reference text is available to guide the assessment and a comment box is available to record qualitative information about the patient's sleep. A link to the 'Getting It right for sleep at night' guideline TAG NSW website is also provided in the electronic medical record, It is not diagnostic but rather provides a means to follow trends in patient's sleep quality and provides a gauge of the effectiveness of interventions designed to promote and maintain their sleep. Implementation will be predominately delivered by an experienced clinical nurse researcher in the study wards with input from the investigator team of clinicians and will include: *One to one academic detailing with health professionals (nurses, medical doctors) including a standardised script i.e., a brief summary of the 'getting it right for sleep at night' guideline, availability and location of eye covers and ear plugs, location of sleep assessment scale in the electronic medical record and how to use it (location of reference text). This will be delivered in the clinical setting while shadowing individual clinicians. The total time spent with each clinician will not exceed 5 minutes (depending on individual need). *Email communications using unit / ward based email list serves (bi-monthly) outlining usage rates of the sleep assessment and reminders about the 'getting it right for sleep at night' guideline. *Face to face 20- 30 minute education sessions with small groups of nurses in the ward setting (bimonthly) including a summary of the study methods, the guideline, location of ear plugs and eye covers and location of the sleep assessment scale and how to use it and progress with uptake of the scale. In addition information about sleep and shift work will be provided to assist nurses with their own sleep hygiene. Sessions will be provided on site in a room close the clinical setting and information will be delivered using PowerPoint slides. *Posters and visual information available from the 'Getting it right for sleep at night' website tool kit will be displayed in the clinical setting in areas frequently attended by clinicians e.g., doors of store rooms, education notice boards. *Feedback about the usage of the sleep scale (aggregate frequency) will be obtained using an electronic medical record audit (number of patients and number of scales completed downloaded) and will be the main measure of adoption (adherence) and will be provided to health care professionals (as described above). The implementation phase will be conducted over 6 - 12 months.