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Lookup NU author(s): Dr Kirstie Anderson, Arne Wolters, Dr Patrick Keown
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Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved. Objective: – Sleep disturbance in hospital predicts worse mental health outcomes and is associated with increased length of stay. Enhanced observations are used routinely on mental health wards but disturb sleep and may not be needed for all patients. We have implemented a sleep improvement program (SleepWell) across multiple hospitals within a large UK mental health trust over 5 years. This includes ward adaptations to reduce night noise, increase daytime activity and natural light, screening for sleep disorders, and a 6-hour protected overnight sleep period if assessed as safe. Our objective was to assess the long-term patient safety and potential benefits of a ward-based sleep improvement program that includes a protected sleep period. Methods: – A detailed review of every inpatient mortality was undertaken over 4 years with a comparison of age-adjusted mortality rates and both their causes and the time of death on wards with and without the SleepWell program. Results: – Protected sleep was seen to be safe; there were 77 deaths over the 4 years, with the majority in older adults, but specifically there were no deaths that occurred overnight or during a protected sleep period. Older adult wards that implemented the SleepWell program had lower mortality rates than those that did not over the 4 years. Conclusions: – We challenge the perceived benefit to patient safety of frequent overnight observations for all inpatients and suggest that nursing observations that disturb sleep may increase risk in themselves. A ward-based sleep improvement program that includes a protected sleep period can be safely implemented, but staff education and a personalized risk assessment are key.
Author(s): Anderson KN, Weddle R, Cape H, Wolters AT, Keown P
Publication type: Article
Publication status: Published
Journal: Journal of Patient Safety
Year: 2026
Pages: Epub ahead of print
Online publication date: 09/04/2026
Acceptance date: 02/04/2018
ISSN (print): 1549-8417
ISSN (electronic): 1549-8425
Publisher: Lippincott Williams and Wilkins
URL: https://doi.org/10.1097/PTS.0000000000001506
DOI: 10.1097/PTS.0000000000001506
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