repo vironnemen u ueri larm rui i rt an … stop the noise.pdf · alarm brui voi fort san cess...
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ALARMES BRUITS VOIX FORTES SANS CESSE DERANGEANT MANQUE DE SOMMEIL SANS REPOS ENVIRONNEMENT POUR GUERIR ALARMES BRUITS VENVIRONNEMENT SSE DERANGEANT MANQUE DE SOMMEIL SANS REPOS ENVIRONNEMENT POUR GUERIR ALARMES BRUITS VOIX FORTES SANS CESSE DERANGEANT MANQUE DE SOMM SANS REPOS ENVIRONNEMENT POUR GUERIR ALARMES BRUITS VOIX FORTES SANS CESSE DERANGEANT MANQUE DE SOMMEIL SANS REPOS ENVIRONNEMENT POUR GUERIR ALARMES BRUITS VOIX FORTES SANS CESSE DERANGEANT MANQUE DESOMMEIL SAN NVIRONNEMENT POUR GUERIR ALARMES VOIVOIX FORTES SANS CESSE DERANGEANT MANQUE DE SOMMEIL SANS REPOS ENVIRONNEME POUR GUERIR ALARMES BRUITS VOIX FORTES SANS CESSE DERANGEANT MANQUE DE SOMMEIL SANS REPOS ENVIRON POUR GUERIR ALARMES BRUUITS QUIITS VOIX FORDERANGE SANS CESSE DERANG SANS REPOS ENVIRONNEMENT POUR GUERIR ALARMES BRUITS VOIX FORTES SANS CESSE DERANGEANT MANQUE DE SOMMEIL SANS REPOS ENVIRONNEMENT POUR GUERIR ALARMES BRUITS VOIX FORTES SANS CESSE DERANGEANT MANQUE DE SOMM UITS SANS REPOS ENVIRONNEME POUR GUERIR ALARMES BRUITS VOIX FORTES SANSCESSE DERANGEANT MANQUE DE SOMMEIL SANS REPOS ENVIRONNEMENT POUR GUERIR ALARMES BRUITS VOIX FORTES SANS CESSE DERANGEANT MANQUE DE SOMME SANS REPOS ENVIRONNEMENT POUR GUERIR alarmsnon stop talking loud noises no rest disruptions no healing environment loud alarms ringing beeping talking RESTINGloudly constant noise no rest disruptions healing environment talking alarms ringing beeping talking loudly constant noise no rest disruptions healing environment loud alarms ringing beeping talkiNg loudly constant noise no rest disruptions healing environment loud noise ringing beeping talking loudly constant noise non stop rest disuptions healing environment loud alarms ringing beepinG talking loudly constant noise no rest disruptions healing environment loud alarms ringing beeping talking loudly constant noise no rest disruptions healing environment loud alarms beeps loudNESS
talking loudly constant noise no rest disruptions healing environment nonstop loud alarms ringing beeing talking loudly consTant HEALING REST noise non stop no rest disruptions healing environment loud alarms ringing beeping talking loudly constant noise no rest disRuptive non stop no rest healing environment loud alarms ringingeeping talking loudly constant noise non stop HEALING
ALARMES BRUITS VOIX FORTES SANS CESSE DERANGEANT MANQUE DE SOMMEIL SANS REPOS ENVIRONNEMENT POUR GUERIR ALARMES BRUITS VENVIRONNEMENT SSE DERANGEANT MANQUE DE SOMMEIL SANS REPOS ENVIRONNEMENT POUR GUERIR ALARMES BRUITS VOIX FORTES SANS CESSE DERANGEANT MANQUE DE SOMM SANS REPOS ENVIRONNEMENT POUR GUERIR ALARMES BRUITS
VOIX FORTES SANS CESSE DERANGEANT MANQUE DE SOMMEIL SANS REPOS ENVIRONNEMENT POUR GUERIR ALARMES BRUITS VOIX FORTES SANS CESSE DERANGEANT MANQUE DESOMMEIL SAN NVIRONNEMENT POUR GUERIR ALARMES VOIVOIX FORTES SANS CESSE DERANGEANT MANQUE DE SOMMEIL SANS REPOS ENVIRONNEME POUR GUERIR ALARMES BRUITS VOIX FORTES SANS CESSE DERANGEANT MANQUE DE SOMMEIL SANS REPOS ENVIRON POUR GUERIR ALARMES BRUUITS QUIITS VOIX FORDERANGE SANS CESSE DERANG SANS REPOS ENVIRONNEMENT POUR GUERIR ALARMES BRUITS VOIX FORTES SANS CESSE DERANGEANT MANQUE DE SOMMEIL SANS REPOS ENVIRONNEMENT POUR GUERIR ALARMES BRUITS VOIX FORTES SANS CESSE DERANGEANT MANQUE DE SOMM UITS SANS REPOS ENVIRONNEME POUR GUERIR ALARMES BRUITS VOIX FORTES SANSCESSE DERANGEANT MANQUE DE SOMMEIL SANS REPOS ENVIRONNEMENT POUR GUERIR ALARMES BRUITS VOIX FORTES SANS CESSE DERANGEANT MANQUE DE SOMME SANS REPOS ENVIRONNEMENT POUR GUERIR alarmsnon stop talking loud noises no rest disruptions no healing environment loud alarms ringing beeping talking RESTINGloudly constant noise no rest disruptions healing environment talking alarms ringing beeping talking loudly constant noise no rest disruptions healing environment loud alarms ringing beeping talkiNg loudly constant noise no rest disruptions healing environment loud noise ringing beeping talking loudly constant noise non stop rest disuptions healing environment loud alarms ringing beepinG talking loudly constant noise no rest disruptions healing environment loud alarms ringing beeping talking loudly constant noise no rest disruptions healing environment loud alarms beeps loudNESS talking loudly constant noise no rest disruptions healing environment nonstop loud alarms ringing beeing talking loudly consTant HEALING REST noise non stop no rest disruptions healing environment loudalarms ringing beeping talking loudly constant noise no rest disRuptive non stop no rest healing environment loud alarms ringing eeping talking loudly constant noise non stop HEALING sg ALARMES BRUITS VOIX FORTES SANS CESSE DERANGEANT MANQUE DE SOMMEIL SANS REPOS ENVIRONNEMENT POUR GUERIR ALARMES BRUITS VENVIRONNEMENT SSE DERANGEANT MANQUE DE SOMMEIL SANS REPOS ENVIRONNEMENT POUR GUERIR ALARMES BRUITS VOIX FORTES SANS CESSE DERANGEANT MANQUE DE SOMMEIL SANS REPOS ENVIRONNEMENT POUR GUERIR ALARMES BRUITS VOIX FORTES SANS CESSE DERANGEANT MANQUE DE SOMMEIL SANS REPOS ENVIRONNEMENT POUR GUERIR ALARMES BRUITS VOIX FORTES SANS CESSE DERANGEANT MANQUE DESOMMEIL SAN NVIRONNEMENT POUR GUERIR ALARMES VOIVOIX FORTES SANS CESSE DERANGEANT MANQUE DE SOMMEIL SANS REPOS ENVIRONNEME POUR GUERIR ALARMES BRUITS VOIX FORTES SANS CESSE DERANGEANT MANQUE DE SOMMEIL SANS REPOS ENVIRON POUR GUERIR ALARMES BRUUITS QUIITS VOIX FORTES DERANGE SANS CESSE DERANG SANS REPOS ENVIRONNEMENT POUR GUERIR ALARMES BRUITS VOIX FORTES SANS CESSE DERANGEANT MANQUE DE SOMMEIL SANS REPOS ENVIRONNEMENT POUR GUERIR ALARMES BRUITS VOIX FORTES SANS CESSE DERANGEANT MANQUE DE SOMM UITS SANS REPOS ENVIRONNEME POUR GUERIR ALARMES BRUITS VOIX FORTES SANSCESSE DERANGEANT MANQUE DE SOMMEIL SANS REPOS ENVIRONNEMENT POUR GUERIR ALARMES BRUITS VOIX FORTES SANS CESSE DERANGEANT MANQUE DE SOMME SANS REPOS ENVIRONNEMENT POUR GUERIR alarmsnon stop talking loud noises no rest disruptions no healing environment loud alarms ringing beeping talking RESTINGloudly constant noise no rest disruptions healing environment talking alarms ringing beeping talking loudly constant noise no rest disruptions healing environment loud alarms ringing beeping talkiNg loudly constant noise no rest disruptions healing environment loud noise ringing beeping talking loudly constant noise non stop rest disRuptions healing environment loud alarms ringing beepinG talking loudly constant noise no rest disruptions healing environment loud alarms ringing beeping talking loudly constant noise no rest disruptions healing environment loud alarms beeps loudNESS talking loudly constant
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Stop the Noise : A Quiet Environment Promotes Healing MAI NGUYEN RN, BScN, CCRN, CNRN, CNCC(c) , JULIE KINNON BScN, MScN, BEA KRISTINE CANAPI RN, BScN , MARTIN DARBOUZE RN, BScN , JOSIE DEL CAMPO RN, CNCC(c) , WINSOME WRIGHT RN, BScN
INTENSIVE CARE UNIT - MONTREAL GENERAL HOSPITAL, MCGILL UNIVERSITY HEALTH CENTRE
References* Other members of the Project Committee: Jacynthe Caron, Amanda DiFlorio, Margaret Hemmings,
Seny Lopez, Olga Novak, Myriam Pelletier, Nola Young * Contributors to visuals: Eshwari Ambalapady, Louise Beauregard, Andrei Belkin, Josie del Campo, Nadia Feroze, Akeyicha Gittens, Dr. Ash Gursahaney, Dr. David Hornstein, Julie Kinnon, Tony Paolucci * The staff of the Montreal General Hospital ICU for their participation. * The management team of the Montreal General Hospital ICU for their support.
Acknowledgements MAI NGUYEN JULIE KINNON
[email protected] [email protected]
Further Information Affiliations
. . . W H A T W E D I D . . .I N T R O D U C T I O N
L I T E R AT U R E R E V I E W
M ET H O D
Most ICU environments have noise levels far above the World Health Organization (WHO) recommendations. Excessive noise in ICU has been found to have negative impacts on the physiological and psychological health of patients. Important links between error rate and environmental noise have been established. Noise reduction strategies aimed at behaviour change have revealed a reduction in environmental noise in hospitals. This quality improvement project sought to raise awareness of noise in our unit and test out strategies to create a quiet healing environment for our patients and families.
[1] WHO states that hospital noise levels should not exceed 45dB(A) during the day and 30 dB(A) during the night. [2] Studies in ICUs reported average noise levels of 60-70 dB(A) with peaks over 90dB(A). [3] Negative effects of noise on patients include: sleep disturbance, increased stress response, immunosuppression, delirium, and delayed healing.[4] Equipment alarms ringing near ICU patients’ heads contributes to interruption of sleep.[5] Patients and families felt private rooms were quieter but hallway noise continued to be a problem.[6] Measured noise levels before and after an educational and awareness campaign indicated noise reduction.[7] Earplugs could be a reasonable noise-reduction strategy for improving sleep in certain ICU patients.
• Sound meter measurements before and after the project.
PHASE ( 3 ) IMPLEMENTING STRATEGIES TO REDUCE NOISE LEVELS
“Stop the Noise - A Quiet Environment Promotes Healing” was a project pioneered by ICU nurses to highlight the issue of excessive noise in the ICU. This quality improvement project was successful in raising the nurses’ awareness of noise in our unit. Results of our surveys and sound measurements established that noise is disturbing and that some simple strategies can make a difference in the “health” of our environment.
We look forward to future developments of this project in order to sustain this change. We aim to continue developing new signage and awareness strategies, to include ancillary and profes-sional staff in the project and to consider a “noise policy” in our unit. Finally, we would like test the use of earplugs on appropriate patients and consider conducting a formal research project.
CONCLUSION
L I M I TAT I O N S•Projectwasdirectedmostlytowardsnurses.• Low survey response rate (patient & family survey, post-intervention nursing survey).• Environmental variability during sound measurements.
O U T C O M E S
PHASE ( 2 ) IS NOISE AN ISSUE IN OUR UNIT?
SOUND LEVEL COMPARISON
• Survey (before project): - staff perception - patient & family perception•Survey (after project):
staff perception & behavioral change
O B J E C T I V E S
• 14 Staff Nurses - volunteers.• Task division: survey & intervention groups.• Communication via monthly meetings & e-mail.
•Explorenurses’perceptionsofnoiseanditsimpactonpatients.•Sensitizenursestothenegativeimpactofnoiseonpatients,familyandstaff.•Identifysourcesofnoiseinourunit.•Developunit-basednoisereductionstrategies.•Evaluatetheimpactoftheprojectonstaffandtheenvironment.
PHASE ( 1 )FORMING THE PROJECT COMMIT TEE
SOUND MEASUREMENTS
STAFF SURVEY
PATIENT & FAMILY SURVEY
EDUCATION ACTIONS
•University-affiliatedteachinghospitalinMontreal(~500beds)• ICU staff with variable levels of experience.• Staff and patients from a culturally diverse population.
SETTING
[1]Dennis,C.M.etal(2010).BenefitofQuietTimeforNeuro-IntensiveCarePatients,JournalofNeuroscienceNursing,42(4),217-224. [2] Cmiel, C.A. et al (2004). Noise Control: A Nursing Team’s Approach to Sleep Promotion. American Journal of Nursing, 104(2), 40-48. [3] Lower, T.S., Bonsak, C., Guion, J. (2003). Peace and Quiet Nursing Management, 34(40), 40A-40D. [4] Tracy, M.F. & Chlan, L. (2011). Nonpharmacological Interventions to Manage Common Symptoms in Patient Receiving Mechanical Ventilation. Critical Care Nurse. 31(3). 19-27 [5] Trochelman, K. Albert, N.et al (2012). Patients and their Families Weigh In on Evidence-Base Hospital Design. Critical Care Nurse, 32(1), e1-e10. [6] Duart et al. (2012). Practicing Silence: Educational Intervention For Reducing Noise In The Intensive Care Unit. Rev. Bras. Enferm. 65(2): 285-90. [7] Rong-Fang, H., Xiao-ying et al. (2010). Effects of Earplug, Eye Masks on Nocturnal Sleep, Melatonin and Cortisol in a Stimulated ICU Environment. Critical Care. 14: R66
MEDICATION PREPARATION AB OVE LI G HT SWITCH ES
AB OVE VENTI LATO RN EAR M O N ITO R / IV PU M PS
• Poster emphasizing negative impact of noise.• Presentation &
discussion during AM Nursing Rounds• Posting of current
journal articles• Distribution of
handouts >>>
A Quieter Environment - One Voice at a Time
Why reducing unnecessary noise is
important to our patients?
* Noise reduction helps them heal.* 4 to 5 hours of continuous sleep decreases overall stress levels.* Patients who get adequate sleep are better able to participate in their care.* No one likes interruptions when trying to fall asleep.* Noise management is part of total patient care.* Good service is partly defined by a quiet healing environment.
• Reducing volumes on phones and IV pumps.• Adjusting music volume to
patients’ preference.• Closing doors during
rounds & at night.
• Lowering alarm monitor volumes.• Individualizing alarm
parameters.• Responding quickly to
alarms, call bells & phones.• Sound level measurements in patient rooms
and the hallways were taken during day, evening and night.• The following were also measured:
Empty Room (no equipment) - 50 db(A) CT (portable) - 72 dB(A) POD Meeting - 65-75 db(A) Monitor Alarm - 79 dB(A) IV Pump Alarm - 70 dB(A) Phone Ring - 60-70 dB(A) Humidifier - 100 dB(A)
0 10 20 30 40 50 60
Health-‐care
Housekeeping staff/
Medical devices
Phones rings
Footsteps
Noise Contributors
[%] 0 10 20 30 40 50
Very Fast
Fast
Slow
Very Slow
Not at All
Patient Survey on RNs' Alarm Response Rate
[%]
SIGNAGE QuotestoRememberandMakePartofourCare
EveryoneCanHelpPromoteaQuiet,HealingEnvironment
Reminding&EncouragingChangeinPractice
Random sound level measurements before and 8 months after project implementation revealed some noise reduction.
STAFF SURVEY RESPONSES Nurses answered a survey with open-ended questions 8 months after the project.
Nurses were able to identify safe dB(A) levels.
Nurses identified noise-reduction strategies they had used.
“ I now try closing patient room doors more often.”“ I speak more quietly outside patient rooms. ”“ I avoid crushing pills when I can.”
Nurses described important risk factors of noise.
“ Sleep deprivation ” “ Increased error rate ”“ Psychosis & restlessness”
Nurses are thinking about future strategies.
“ Music therapy ”“ Place sound measuring devices in the unit. ”“ Establish non-disturbance periods. ”“ Involve others in the project (e.g. housekeeping, physicians) ”
Nurses felt positively about the signage.
“ The signage reminded people to be quiet. ”“ The SILENCE and HEALING poster reminded me of the impact of noise. ” “ I was happy to see the reminder to reduce pill crushing. ”
Nurses felt families were impacted
by noise.
“ Noise can be perceived as unprofessional. ”“Noise added to their stress level. ”
M ed I CAL/SU RG I CAL/T R A U M A I C U : 2 2 B E D S , H A L LWAY D E S I G N
IN FRONT OF PATIENT ROOMS
UNIT MAIN ENTRANCE0 20 40 60 80 100
Are you often awoken by excessive noise in the ICU?
Do monitoring alarms interfere with your sleep?
Will music in your room help you sleep?
Yes No [%]
0 20 40 60 80 100
Do frequent warning alarms interfere with care delivery to patients?
Do you experience "alarm fatigue" when working in the ICU?
Do patients develop anxiety, panic, or paranoia from overhearing conversations between staff?
Yes No [%]
0 10 20 30 40 50 60 70 80 90 100
Recurrent warning alarms can reduce trust in seriousness of the call
Excess noise and monitor alarms have a substantial impact on patients' sleeping pattern
Excess noise and alarms can increase stress, anxiety and confusion in ICU patients
Strongly Agree Agree Disagree Strongly Disagree [%]
0 10 20 30 40 50 60 70 80
Before A1er Before A1er Before A1er
DAY EVENING NIGHT
Noise Levels in the ICU Before and After Applying Noise Reduction Measures
[dB]
QUANTITATIVE
QUALITATIVE