In the medical nursing unit of Stanford Hospital & Clinics in Palo Alto, California, the hallways weren't as quiet as they were supposed to be. The culprit turned out to be linen supply closet doors. Designed to close quietly, they were actually banging shut at night and keeping patients awake.
In order to reduce the noise pollution, the facility instituted the Night Shift Noise Reduction Project using SHHH (Silent Hospitals Help Healing) signs. Instead of stuffing towels around the doors to deaden the noise, the door signs urged nurses to call the General Services Response Center to adjust the door-closing mechanisms. The facility also began unloading supplies quietly at night.
"We won't see data until June," Chuck Pitkofsky, RN, MSN, a member of the Noise Reduction team, said of whether the system had reduced noise in the unit. "But anecdotally, nurse managers are telling us they feel it’s quieter."
When Pitkofsky, Jodi Blanchard, Dan Polcyn, Buffie Stark, Carlos Villalva and Carol Walovich were tapped last September to form a team and pick a project for the SHC Leadership Academy, they decided they needed to determine the source of the noise. Four nursing units had scored poorly on the Picker survey, a national patient-satisfaction instrument that is mailed to patients after they are discharged. Responses to a question asking about night shift noise levels had drawn consistently poor numbers in those units.
The Noise Reduction team was expanded to include the nurse managers from the four units. Nighttime visits to those units with a decibel meter in hand confirmed that the there were multiple causes of noise at the hospital. Service carts rattled over threshold strips, HVAC units wheezed, water pipes gurgled, helicopters landed and took off, telephones rang and voices rose at nursing stations. There were also endless beeps emanating from monitors, keypad codes and IV alarms.
"The alarms can't be turned off, and the noise can escalate from there," said Myra Lang, RN, MS, CCRN, patient care manager of unit B2 for intermediate cardiac care. "People talk more loudly to be heard over the alarms, and when a phone rings, you have to talk over that."
Lang herself has been a patient at Stanford Hospital twice in recent years, and she brought a singular perspective to the questions asked by the Noise Reduction team. While she said she felt more relaxed with her door open and hearing the noise of the unit, "I expect noise, I live with it every day."
The Noise Reduction team looked at the kinds of noises they realistically could reduce, and decided on some immediate interventions. First came signage. SHHH posters were hung at nursing stations and at the doors to patient units, urging quiet with a stylized finger on cartoon-strip lips. The team also purchased two "SoundEars," LED displays in the shape of a human ear that light up green, yellow or red when noise thresholds are crossed. The ears were rotated among the four pilot units to continuously monitor the noise for a week.
Pitkofsky’s nursing unit is located above a first-floor construction project. In the early days of the project he went downstairs to the site to check out workers’ earplugs. The Noise Reduction team promptly ordered the same earplugs for hospital patients—foam plugs with a noise-reduction rating of 33.
Another intervention came from nurses’ requests for the kind of pulse-oximeter probes that routinely are used in intensive care units to monitor oxygen levels in a patient’s blood. The ICU probes are more expensive but also stay on patients’ fingers better, thereby avoiding the false alarms that sound if the probes inadvertently slide off.
Finally, each nursing unit was encouraged to appoint a "noise champion" to be responsible for customizing noise reduction strategies on his or her floor.
Although the pilot project ended in April, Pitkofsky said a patient survey developed by the team is still being distributed in a number of nursing units. "Our recommendation would be to continue with the survey and the noise reduction strategies, which we hope to roll out to the rest of the hospital in the near future," he said.
Source: Stanford Hospital and Clinics