Wednesday 29 August 2018

The constant high levels of noise in intensive care units hurt patient recovery as it can cause to sleep deprivation, increased pain perception and even heightened delirium. At the end of a 6-month project implemented by nurses in a neurosurgical intensive care unit (NSCU), they concluded that “limiting conversations, eliminating environmental noise, and dimming the lights as a reminder to be quiet are three simple strategies that can be implemented to lessen noise” during planned daily quiet times.

Nursing Career, Nursing Skill, Nursing Profession, Nursing Responsibilities

Nurses working in the 16-bed neurosurgical ICU at North Shore University Hospital in Manhasset, New York, identified noise as a problem on their unit. They agreed to introduce quiet times for two hours twice a day – from 3 am to 5 am and 3 pm to 5 pm – with the goal of reducing noise levels during these times by 10 decibels within six months.


The research had shown that patients do sleep better during quiet times and that it also reduced the stress levels of staff. Studies had further demonstrated that most noise in ICU’s could be attributed to staff conversations. For sleeping environments, the World Health Organization recommends background noise of less than 30 dB, with single noise events not exceeding 45 dB.

At the start of the project, nurses collected baseline data for eight days by measuring noise levels at four locations in the unit every 30 minutes during the chosen times. This was followed by education sessions for all healthcare and support staff on the NSCU team. The measured data was shared to increase awareness of noise and discussions were held on the benefits of quiet times.

The noise reduction plan was introduced a week after the education was completed. Strategies included completing patient procedures and other activities before or after the designated hours, reducing conversations and speaking with lowered voices, as well as dimming lights as a visual cue that quiet time was in force. The team also made use of notices on doors and pamphlets, while unit staff monitored each other and reminded visitors to observe the quiet times.

As the project progressed, consultants and other members of the healthcare team adapted to the quiet time environment and some even changed the timing of their visits to the unit so that their rounds would be completed before the quiet time. Staff also identified that the monitor alarms were adding excessive noise. The unit had a smart-monitor upgrade and the alarm parameters and default settings of some patient monitoring devices were adjusted as well.

The noise measurements were repeated after six months. A peak noise reduction of 10-15 dB during the prescribed quiet times had been achieved and was statistically significant in two of the four locations. Because of the layout of the unit, with the patient’s rooms being near the centralized the nurses’ station, as well as the constant moving of patients in and out of the unit, it was impossible to achieve noise reduction to the level recommended for sleeping.

Particularly meaningful though was that, through their commitment, the team was able to maintain the quiet time and the noise reduction for six months after implementation of the project.


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