Assessment of Sleep Quality and Modifiable Disruptors in Postoperative Paediatric Patients: A Clinical Audit.

Abstract

Background Sleep disruption is common during postoperative hospitalisation and may be influenced by pain, overnight clinical care, and environmental factors. This quality improvement project assessed sleep quality among postoperative paediatric inpatients and identified potentially modifiable contributors to sleep disturbance. Methodology A clinical audit was conducted on a paediatric inpatient ward between April and June 2026. Children aged 0-18 years admitted following elective or emergency orthopaedic surgery and requiring at least one overnight postoperative stay were eligible. Parents or carers completed a questionnaire after the child's first postoperative night assessing sleep quality, nighttime awakenings, causes of sleep disturbance, ward noise and lighting, clustering of overnight care, assessment of sleep needs, and parent/carer sleep. Responses were analysed descriptively using frequencies and percentages. Results In total, 19 questionnaires were included: 14 from children accommodated in multi-bed bays and five from children in individual cubicles. In bays, eight of 14 (57.1%) children were reported to have fair sleep and six (42.9%) woke more than five times overnight. In cubicles, two of five (40.0%) children were reported to have good sleep and one (20.0%) woke more than five times. Nursing observations were reported as a contributor to sleep disturbance in 10 of 14 (71.4%) children in bays and four of five (80.0%) in cubicles. Pain contributed to sleep disturbance in 10 of 19 (52.6%) children overall. Most respondents reported that the ward was quiet overnight and that lights were kept low. However, only seven of 19 (36.8%) families reported being asked about their child's sleep needs. Parent/carer sleep was also frequently disrupted. Conclusions Postoperative sleep disruption was common, with nursing observations and pain among the most frequently reported contributors. Despite generally favourable perceptions of overnight noise and lighting, opportunities for improvement were identified in assessment of individual sleep needs, coordination of overnight care where clinically appropriate, and optimisation of pain management. A subsequent audit cycle following implementation of these measures will assess their impact on sleep-related outcomes.