Quiet Please, I M Trying To

Transcription

1 Quiet Please, I M Trying To Recover Ruth Haydock, RN, BScN, CNCC Marilyn Lee, RN, MN, CNCC Toronto East General Hospital

2 Objectives Identify the need for a change in culture pertaining to noise levels Identify factors which create noise Recognize the impact of high noise levels on patients and staff Demonstrate the process for creating a culture change List strategies to reduce noise levels in the clinical area Discuss evaluation results and outcomes List the next steps

3 Who We Are 15 bed Med/Surg ICU Individual rooms with sliding glass doors 500 bed community teaching hospital in Toronto Culturally diverse population of staff and patients Staff representative of various levels of experience

4 Toronto East General Hospital

5 How We Began ICU Partnership Council Mandate of council Willing to take on project

6 Problem Recognition Noise Levels Patient satisfaction reports Patient discharge phone calls Anecdotal accounts of patient experience Staff satisfaction results ICU partnership council

7 A Healing Environment. Which One Would You Choose?

8 Literature Review Gain knowledge of the impact on staff Gain knowledge of the impact on patients Gain knowledge of the impact on families

9 Literature findings Over half of all patients surveyed reported nighttime noise as problematic during their hospital stay WHO states that hospital noise levels should not exceed 45dB during the day and 35dB at night

10 Literature findings cont d Research has found that noise above the recommended levels has detrimental effects on patients Berglund, B; Lindvall T, Schwela D, Goh KT (1999). "World Health Organization: Guidelines for Community Noise". World Health Organization. Maschke C (2003). "Stress Hormone Changes in Persons exposed to Simulated Night Noise". Noise Health 5 (17): Franssen EA, van Wiechen CM, Nagelkerke NJ, Lebret E (2004). "Aircraft noise around a large international airport and its impact on general health and medication use". Occup Environ Med 61 (5): Lercher P, Hörtnagl J, Kofler WW (1993). "Work noise annoyance and blood pressure: combined effects with stressful working conditions". Int Arch Occup Environ Health 65 (1): 23-8

11 Literature Findings cont d Jackhammer 110 decibels Noise at peak of shift change 113 decibels Heavy truck traffic 80 decibels Bedside monitor alarms 79 decibels

12 Impact on Patients Tachycardia; increase in MAP Disrupted sleep patterns Impaired wound healing Impaired mental and emotional healing Altered immune function Ely et al (2004) Delirium as a predictor of mortality in mechanically ventilated patients in the ICU. JAMA 291:

13 Impact on Staff Tachycardia Increased annoyance ratings Occupational stress and burnout Perceived higher work demands Decrease in performance, teamwork Increase in errors medication, judgment and critical thinking Morrison et al (2003) Noise, stress, and annoyance in a pediatric intensive care unit. Crit Care Med 31: Top et al (1988) Noise-induced stress as a predictor of burnout in critical care nurses. Heart Lung 17: Murthy et al (1995) Detrimental effects of noise on anaesthetists. Can J Anaesth 42:

14 Impact on Families Affects family perception of professional behaviour and judgment Increases stress and anxiety Hinders communication with the health care team

15 How We Dealt With It Two Parts 1. Culture Change 2. Actual Strategies to fix problem

16 Culture Change Development of presentation Video Vocera use Signage Role modeling Shhhhh discussions Multidisciplinary buy in

17 Strategies to Fix Problem Decrease volume on phones, IV pumps Set appropriate individual alarms parameters Close patient room doors especially during shift change and rounds Adjust radio as per patient s preference consider earphone use Ensure maintenance of noise producing equipment ( squeaking wheels, doors and drawers)

18 Strategies cont d Establish quiet hours in the ICU Provide information about quiet hours to patients, families and staff Post signs throughout the unit at entrances and patient doors Involve the interdisciplinary team in noise reduction campaign

19 Strategies Cont d Encourage staff to congregate in designated areas other than the nursing station Use Vocera to call nurses instead of phone in patient room Discourage unnecessary traffic through the unit Adopt a universal symbol to remind staff of noise levels Shhhh man sign

20 Shhhhhh

21 Rolling it out ICU staff meetings, council, desk top presentation available Interdisciplinary Critical Care Education Rounds Central Partnership Council Dynamics Poster

22 Outcomes/Evaluation Questionnaire Anecdotal comments Shhhh respected Core Service Standards Acceptance of the norm Role Modeling Shift Change

23 Next Steps Sustainability Reaching out to other disciplines Educating Patients and Families Hospital Wide Acceptance policy development Corrections to Guide to ICU

24 For more information: Marilyn Lee Toronto East General Hospital 825 Coxwell Ave. Toronto, Ontario M4C 3E7 Tel: (416) ext Above all, we care.