Effectiveness of an interdisciplinary sleep/wake bundle to decrease agitation, mechanical restraints usage, and length of stay for individuals with traumatic brain injury in the hospital.

Research Objectives: To investigate the effectiveness of an interdisciplinary sleep/wake bundle in decreasing agitation, usage of mechanical restraints, and length of stay after traumatic brain injury (TBI) in the hospital setting.

Design: A mixed-method design was used to measure time in mechanical restraints and length of stay. Data was collected beginning in January 2021 and continues at present time.

Setting: The study setting is a Level I Trauma hospital in a geographically isolated location with minimal post acute resources.

Participants: Inclusion criteria; diagnosis of TBI, 14 years of age or older, agitation, and requiring greater than q6 neurological checks . If criteria were met, the patient was flagged during interdisciplinary trauma rounds. If the criteria were not met, care remained unchanged.

Interventions: The care bundle included a daytime and sleep routine supported by evidence-based interventions. The Occupational Therapist (OT), having clinical expertise in cognitive and physical functioning, created a daytime schedule in collaboration with the physical therapist (PT), speech therapist (SLP), patient, and family. The schedule included set times for OT, PT, SLP sessions, meal times, time allotted for brain rest, and mobility recommendations based on the patient's current level of function. For the sleep aspect, vital signs and medication were administered prior to the designated sleep time. Evidence-based strategies were implemented to create a quiet and calm environment to minimize overstimulation. No interruptions occur between the hours of 2300 and 0500 with an exception for any safety concerns. Once the sleep/wake bundle was initiated, it continued for the remainder of that patient's hospitalization.

Main Outcome Measures: 1) Time spent in mechanical restraints
2) Length of stay

Results: Data collected suggests the care bundle led to decreased length of stay while restraint usage was inconclusive.

Conclusions: Implementation of an interdisciplinary sleep/wake bundle for management of agitation after acute TBI increases clinician confidence, decreases length of stay, and improves interdisciplinary communication. This evidence-based care bundle could be translated for use in other similar acute hospital settings.

Author(s) Disclosures: The authors have no conflicts of interest to disclose.