560 - Evening Screen Use in the PICU: Associations with Sleep, Delirium, and Medication Use

Publication Number: 560.4840

Madeline R. Kotz, University of Minnesota, Minneapolis, MN, United States; Kevin Zhan, University of Minnesota Medical School, Minneapolis, MN, United States; Benjamin Langworthy, University of Minnesota, Minneapolis, MN, United States; Lindsey L. Fast, University of Minnesota Masonic Children's Hospital, Saint Paul, MN, United States; Maria Kroupina, University of Minnesota Medical School, minneapolis, MN, United States; Arif Somani, University of Minnesota, Plymouth, MN, United States

Background: The quality of the inpatient environment plays an important role in illness recovery. This is especially pronounced in the critical care unit where several environmental factors may interfere with rest and sleep. An environmental factor that has not been well-documented is the use of screen devices. Understanding the association between sleep and screen use in the hospitalized child may be important as we seek to create a more restful environment for patients and mitigate poor sleep and its consequences.

Objective: To observe the evening intensive care room environment and explore associations with sleep onset time, delirium, and medication use.

Design/Methods: Patient rooms were observed for 25 evenings in the combined PICU/CVICU at an academic children’s hospital. All patients 18 years or younger were screened for eligibility. Patients were excluded if they were in the immediate 12-hour postoperative period, on paralytics, anesthetized, under EEG monitoring, or on significant life support modalities. We observed the room environment, noting lights, sounds, and active or passive screen engagement, every 15 minutes between 8:00pm and midnight. Additional variables included sleep onset time, CAPD delirium scores, and the use of medications that modulate sleep and delirium.

Results: In total, 2708 observations were undertaken over the 25 observation nights. Patients asleep with a screen on had a greater probability of reawakening than patients asleep without a screen on (OR = 1.95; 95% CI = 1.03, 3.70; p = 0.041). Night-time screen use, however, was significantly associated with decreased analgesia use (total: OR = 0.77; 95% CI = 0.63, 0.95; p = 0.013, active: OR = 0.69; 95% CI = 0.49, 0.97; p = 0.035) and lower CAPD scores (active: p = 0.041, passive: p = 0.016). After adjusting for age, there was no significant association between screen use and sleep onset time.

Conclusion(s): Active engagement with screen media is associated with a lower odds of requiring additional analgesia, and both active and passive screen use are associated with a lower CAPD score the following day. In this study, screen use may be a marker of patient engagement, assisting with orientation to their surrounding environment and resulting in lower delirium scores and a decreased odds of requiring additional analgesia. However, having a screen on while sleeping is associated with a greater odds of reawakening. Therefore, screen use may be a point of intervention to improve the inpatient environment for rest, particularly by ensuring screens are turned off when patients are asleep.