Reducing the risks of delirium: Implementation of ‘Protected Sleep Time’                                                         in Adult Critical Care Units across Lancashire and South Cumbria




Patients frequently report disturbed sleep as one of the negative experiences of being in hospital. This is especially the case in the highly technical critical care environment, where noise/light levels and interruptions to patients can remain high overnight due to the intensive monitoring and treatment required by severely ill patients.

A sleep improvement research study, conducted in Royal Preston Hospital in Spring 2012 (Patel 2014), introduced a bundle of simple, low-cost interventions which improved the quality of patient sleep and halved the incidence of delirium in critical care patients. The Network aims to establish this intervention as best practice across critical care units in the region by promoting the Protected Sleep Time concept through the local quality improvement lead nurses (QuILs) at each hospital site.

Implementation of 

‘Protected Sleep Time’ in Critical Care

A novel implementation toolkit has been developed to establish protected sleep time into practice. This consists of a Network Delirium Guideline along with an info graphic and interactive poster.
The animated info graphic has been created to educate staff about protected sleep time and the interactive poster plays video instructions of the interventions when triggered by smartphones/iPads. To measure the effectiveness of the protected sleep time bundle the QuILs are involved in collecting audit data. This ‘toolkit’ of interventions is being used in 7 critical care units across 4 trusts in Lancashire and South Cumbria. Through application of this bundle of interventions, there is potential to improve patients’ experience of sleep in adult critical care environments. This can significantly reduce their risks of developing delirium.



Patel J, Baldwin J, Bunting P. and Laha S. (2014). The effect of a multicomponent, multidisciplinary bundle of interventions on sleep and delirium in medical and surgical intensive care patients. Anaesthesia. Vol. 69. Pg. 540-549


NICE (National Institute for Health and Care Excellence CG 103, 2010). Delirium: diagnosis, prevention and management.


Sleep Time Poster
Delirium Guideline

For further information, please contact Claire Horsfield (Quality Improvement Lead Nurse) on 01257 245483 or email:


2014 Copyright © Lancashire & South Cumbria Critical Care Network. All Rights Reserved.