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American Academy of Pediatrics
Research Articles

Optimizing Oral Medication Schedules for Inpatient Sleep: A Quality Improvement Intervention

Christine L. Mozer, Palak H. Bhagat, Sarah A. Seward, Noah R. Mason, Samantha L. Anderson, Maxx Byron, Leah B. Peirce, Victoria Konold, Madan Kumar, Vineet M. Arora and Nicola M. Orlov
Hospital Pediatrics April 2021, 11 (4) 327-333; DOI: https://doi.org/10.1542/hpeds.2020-002261
Christine L. Mozer
aPritzker School of Medicine, The University of Chicago, Chicago, Illinois;
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Palak H. Bhagat
bDepartment of Pharmacy and
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Sarah A. Seward
cIS Technology and Applications, Children’s Wisconsin, West Allis, Wisconsin;
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Noah R. Mason
aPritzker School of Medicine, The University of Chicago, Chicago, Illinois;
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Samantha L. Anderson
dSection of General Internal Medicine, Department of Medicine,
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Maxx Byron
dSection of General Internal Medicine, Department of Medicine,
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Leah B. Peirce
eDepartment of Pediatrics, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois; and
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Victoria Konold
fInfectious Diseases and Virology, Seattle Children’s Hospital, Seattle, Washington;
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Madan Kumar
aPritzker School of Medicine, The University of Chicago, Chicago, Illinois;
gSections of Infectious Diseases and
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Vineet M. Arora
aPritzker School of Medicine, The University of Chicago, Chicago, Illinois;
dSection of General Internal Medicine, Department of Medicine,
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Nicola M. Orlov
aPritzker School of Medicine, The University of Chicago, Chicago, Illinois;
hPediatric Hospital Medicine, Department of Pediatrics and
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Abstract

OBJECTIVES: Hospitalized children experience frequent nighttime awakenings. Oral medications are commonly administered around the clock despite the comparable efficacy of daytime administration schedules, which promote sleep. With this study, we evaluated the effectiveness of a quality improvement initiative to increase the proportion of sleep-friendly antibiotic administration schedules.

METHODS: Interprofessional stakeholders modified computerized provider order entry defaults for 4 oral antibiotic medications, from around the clock to administration occurring exclusively during waking hours. Additionally, care-team members received targeted education. Outcome measures included the proportion of sleep-friendly administration schedules and patient caregiver–reported disruptions to sleep. Pre- and posteducation surveys were used to evaluate education effectiveness. Balancing measures were missed antibiotic doses and related escalations of care.

RESULTS: Interrupted time series analysis revealed a 72% increase (interceptpre: 18%; interceptpost: 90%; 95% confidence interval: 65%–79%; P < .001) in intercept for percentage of orders with sleep-friendly administration schedules (orders: npre = 1014 and npost = 649). Compared with preeducation surveys, care-team members posteducation were more likely to agree that oral medications scheduled around the clock cause sleep disruption (resident: 71% pre, 90% post [P = .01]; nurse: 63% pre, 79% post [P = .03]). Although sleep-friendly orders increased, patient caregivers reported an increase in sleep disruption due to medications (pre 28%, post 46%; P < .001).

CONCLUSIONS: A simple, low-cost intervention of computerized provider order entry default modifications and education can increase the proportion of sleep-friendly oral antibiotic administration schedules for hospitalized children. Patient perception of sleep is impacted by multiple factors and often does not align with objective data. An increased focus on improving sleep during hospitalization may result in heightened awareness of disruptions.

  • Copyright © 2021 by the American Academy of Pediatrics
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Hospital Pediatrics: 11 (4)
Hospital Pediatrics
Vol. 11, Issue 4
1 Apr 2021
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Optimizing Oral Medication Schedules for Inpatient Sleep: A Quality Improvement Intervention
Christine L. Mozer, Palak H. Bhagat, Sarah A. Seward, Noah R. Mason, Samantha L. Anderson, Maxx Byron, Leah B. Peirce, Victoria Konold, Madan Kumar, Vineet M. Arora, Nicola M. Orlov
Hospital Pediatrics Apr 2021, 11 (4) 327-333; DOI: 10.1542/hpeds.2020-002261

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Optimizing Oral Medication Schedules for Inpatient Sleep: A Quality Improvement Intervention
Christine L. Mozer, Palak H. Bhagat, Sarah A. Seward, Noah R. Mason, Samantha L. Anderson, Maxx Byron, Leah B. Peirce, Victoria Konold, Madan Kumar, Vineet M. Arora, Nicola M. Orlov
Hospital Pediatrics Apr 2021, 11 (4) 327-333; DOI: 10.1542/hpeds.2020-002261
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