The problem: Hospitalized patients get fewer than five hours of sleep a night.
Poor sleep leads to increased rates of delirium, falls and hypertension, and to lower patient satisfaction scores and longer hospital stays. , ,  Nighttime disruptions – including vital signs, lab draws and medication administration – are a major contributor to poor sleep. These clinical activities can often be shifted to waking hours without compromising patient care.
However, Apex is not currently able to show physicians the orders that will occur at night, or to give physicians the option to easily change them to waking hours.
That’s where Bed Rec comes in.
How it works: Prior to signing out for the day, a provider opens the Bed Rec tab. Under this tab, Apex will list the active orders that will take place during “sleeping hours” from 10pm to 6am. Providers will then have the option, if clinically appropriate, to cancel these orders or shift them to waking hours.
Examples of Bed Rec in use:
- Bed Rec shows vitals are scheduled for Q4 hours, taking place at 8pm, 12am and 4am.
- This patient’s vitals have been stable and suspicion for clinical deterioration is low, so the provider can change vitals to 10pm and 6am
Medications (switch to PRN)
- Bed Rec shows Zofran is a q6 hour “standing” order and is scheduled at 8pm, 2am, 8am
- The provider can change the 2am dose to “PRN” while keeping the daytime doses “standing"
Medications (switch to TID)
- Bed Rec shows amoxicillin is written for Q8 hours and the patient will be woken to receive a dose at 4am
- This medication can safely be given three times a day during waking hours rather than strictly every 8 hours, so the provider can change it to TID and schedule a 6am dose.
- Bed Rec shows that the patient is scheduled for a 4am BMP and CBC.
- The provider can change the labs to 6am.
Obstacles and Concerns:
1. Patient Safety
If we monitor patients less closely at night, will this compromise our ability to recognize clinical deterioration? To address this concern, the Bed Rec tool will have validated decision support built in. The Modified Early Warning Score (MEWS) uses recent vital signs to identify patients who are at high risk for an adverse event or clinical deterioration. Patients with MEWS scores of one or less have adverse event rates of just 5.0 per 1000 patient-days, compared to patients with MEWS of seven or greater, who have adverse event rates of 157.3 per 1000 patient days.
On the page where nighttime vitals are listed, the MEWS score will also be listed in green, yellow or red, and labeled low-, medium- or high-risk for clinical deterioration. Providers will be advised not to forego vitals for the ~50% of patients with a MEWS of greater than one.
2. Will busy residents and attendings really take the time to use this tool?
One of the most common complaints we hear when rounding on patients is that they slept terribly. If the interface is user-friendly and intelligently built to allow for changes with the fewest number of clicks, residents will view this as a “high-yield” use of time. They will be able to give patients eight hours of uninterrupted sleep (a treasured commodity in the medical field) in a minute or less.
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