With a decibel meter, the neurosurgical ICU staff measured noise levels on the left and right sides of the nurses' station—the unit's central hub shared by many providers.
Concerned that noise was negatively affecting family satisfaction, patient sleep, staff stress levels and concentration, nursing staff at North Shore University Hospital in Manhasset, New York, launched an initiative to reduce noise levels in the 16-bed neurosurgical intensive care unit.
The unit reduced noise levels and maintained quiet times with reductions in peak noise events six months after education and implementation.
Here's how they accomplished this.
Staff education
With a decibel meter, the neurosurgical ICU staff measured noise levels on the left and right sides of the nurses' station—the unit's central hub shared by many providers. They also measured noise in front of two patient rooms near the nurses’ station, one of which is near the primary entrance to the unit. Data was collected for eight days prior to staff education and again six months after quiet time was instituted.
After collecting the initial data, baseline results were shared with staff through a variety of ways, including:
- Unit-based in-services
- Staff meetings
- Journal club sessions
Neurosurgical ICU team as well as members of other departments, received education on the benefits of quiet time. All department directors were notified about the initiative.
The unit then implemented quiet time periods twice a day, from 3 a.m. to 5 a.m. and from 3 p.m. to 5 p.m. During quiet times, lights were dimmed, whispering was encouraged, and environmental noise was eliminated as much as possible.
"A darkened unit provided a strong visual cue to be quiet, but reducing noise required a comprehensive team effort," Kerri Scanlon, MSN, chief nursing officer, says in a news release. "Together, we were successful in changing unit practice and enhancing awareness about excessive unit noise."
The Strategies
Specific changes contributing to lower noise levels during quiet time, include:
- Unit secretaries reminding visitors of quiet time, dimming lights, and eliminating overhead paging on the unit.
- Neurosurgical ICU physicians and physician assistants shifting the start of daily teaching rounds to complete them before afternoon quiet time.
- Physical and occupational therapists adjusting their schedules to see patients before 3 p.m.
- Environmental services personnel did not buff floors during quiet time.
- Creating a checklist that itemized tasks to be performed prior to quiet times, such as administering routine medications, taking vital signs, turning off televisions, and putting mobile phones and pagers to vibrate
- Creating a unit-specific brochure explaining quiet times
- Placing signage on each patient door and at unit entrances
- Distributing hospitality bags with items such as sleep masks and earplugs
- Upgrading smart-monitors for each patient room and the central stations to reduce nuisance alarms
- Revisiting alarm parameters and adjusting monitor default settings
The results
After six months, peak noise levels decreased by 10 to 15 decibels lower than baseline data during quiet times.
The difference was statistically significant in two of the four locations, while the two busiest locations experienced quieter but not statistically significant noise reductions.
Opportunities for improvement include:
- Installing push-plate automatic opening functions at the rear entrance to the unit for easier access by emergency department and operating room teams
- Identifying a different time and space for physicians and PAs to conduct teaching sessions
Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.