An inexpensive way to reduce ICU delirium: earplugs for nighttime sleep assistance

Anyone who has been a patient in a hospital at night knows that the conditions for sleep are never ideal. Doors slam, gurneys and meal-wagons are moved around and are banged against walls. Restocking teams walk through the hallways laughing and talking as often do nursing staff members. I once awoke in an ICU at 3:00am to hear an in-service training being conducted out in the open with voices at a volume suited to mid-day not past midnight.
In an ordinary hospital ward the door can be shut to this cacaphony of hospital sounds, but room doors in the ICU are typically left open making it easier for nurses to keep tabs on patients who need to be checked more frequently.

Enter the humble set of foam earplugs. Researchers conducted tests comparing patients who were equipped with earplugs with those who were not so equipped. The result was a marked increase in the quality of sleep in those with earplugs and a decrease in the appearance of deadly delirium, particularly in the first 48 hours. If your loved one is in the ICU, there’s no need to convince a doctor to write an order for this ordinary and humble tool. Bring them in yourself and make sure your patient uses them at night. Also, make certain that staff is informed that ear plugs are in use lest staff conclude erroneously that the patient is non-responsive to verbal requests!

The indispensable role of family members to the ICU patient

One of the most important roles you can play as a family member of someone in the ICU is as a medical historian, specifically in terms of assuring that attending physicians are made fully aware of the patient’s overall pre-ICU cognitive state. Without this information, neither RNs nor MDs nor therapists can properly assess the current condition of your loved one.

 No matter how assertive they are in everyday life, the conditions which brings a person to the ICU will utterly disable them from properly advocating for themselves while they are patients there. It is absolutely critical -often literally a matter of life or death – that loved ones be near their patient 24/7 in the ICU.and that they be willing to be aggressive to a degree which most of us would not think of being outside the hospital.

A change in mentation is inevitably more quickly apparent to a family member than to even the most attentive clinician. Such changes can often be stopped in their tracks by a simple medication adjustment. A delayed or absent adjustment can lead to a very rapid decline and often a quick death.