"Some must watch while others sleep." wrote Shakespeare. His quote has become associated with the care we give to patients when they aren’t able to tell us what they need. Whether patients are actually sleeping, recovering from anesthesia, or in an unresponsive state, they are all relying on their caregivers to watch over them and keep them safe.Because unresponsive patients aren’t able to communicate, they require extra attention to ensure they are comfortable and secure. Every facility is responsible for providing appropriate care for all patients; this means adapting to each patient’s individual needs. How do you know if you’re doing your best for your unresponsive patients? Get a cup of coffee and take time to answer these twenty questions:1. Have you, your managers, and administrators been trained on the special care and needs of unresponsive patients?2. Do new staff members get teamed with experienced preceptors to learn about caring for patients with neurological and cognitive conditions?3. Are staff members who are uncomfortable or unskilled with caring for unresponsive patients given other patient assignments?4. Have you learned about different cultures and generations, so your approach and communication with unresponsive patients is appropriate?5. When a new patient is admitted, do you receive a complete history and care plan?6. Does the entire team take time to get acquainted with the new patient?7. Does your facility provide instructions on how to communicate with an unresponsive patient?8. Do you talk to your unresponsive patients and explain what you’re doing while giving care?9. Can you tell when an unresponsive patient is in pain?10. Do you know how to assess for awareness?11. Do you make rounds on your patients who are unable to communicate?12. Is there a policy for safety checks when caring for unresponsive patients?13. Do you routinely offer comfort measures, such as mouth care?14. Is the patient’s room an appropriate temperature and does the patient have adequate clothing or covers?15. Is the room pleasant, with good lighting and no odors?16. Have you met the patient’s family and learned the patient’s personality?17. Does the patient’s room have a list of his or her preferences to help you maintain the usual routine as closely as possible?18. Does your facility allow disruptive conversations to take place within the hearing distance of an unresponsive patient?19. Does the corporate culture at your facility promote quality care for all patients, including those who are unresponsive or unable to communicate?20. Are you able to provide the same care you would want for your own family member?How many "No" answers did you have? Ideally, none, because your facility knows exactly how to care for unresponsive patients! But if you had more than one or two, consider approaching your manager or supervisor to discuss what could be changed or improved. Perhaps a review of current standards or a new quality project may get everyone on board to "watch while others sleep."