Best Practices: Keeping Quiet
Features
Written by Jill Rose   
Tuesday, 01 April 2008
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Making hospitals a more restful place for patients isn’t all that hard. Nurse manager Elodia Mercier tells us how it’s done.
Most people take for granted that they’re not going to get a good night’s sleep in the hospital. Between nurses caring for patients and changing shifts, beeping monitors, and ringing phones, hospitals are simply not conducive to rest. But since rest is exactly what patients need, and taking things for granted is not her style, Elodia Mercier set out two years ago to change that.

Mercier is the administrative nurse manager at Montefiore Medical Center in The Bronx, and she says the Silent Hospitals Help Healing (SHHH) program has been a major success, resulting in more satisfied patients and happier workers. The numbers back her up—decibel testing done monthly on Mercier’s 34-bed unit shows levels in the mid-60s, a sharp contrast with the 80s and 90s common before the program began.

Mercier said she began the project by measuring the facility at various times using the decibel meter and showing the results to her staff. She then held a contest for an image to put on buttons to be worn by staff and given to family members. “It was fun and encouraged staff to buy into the button because it was something they created,” she said.

Next, Mercier and her staff began asking patients and staff to identify things they felt contributed to noise. Patient mentions of a noisy pill crusher led to the purchase of quiet, individual pill grinders for each nurse on duty. Soft-soled shoes were suggested to eliminate noisy footsteps in the hall, and beepers were switched to vibrate mode.

Several staff members talked about the noisy cart holding the glucometer, preventing them from quietly entering a patient room for early morning blood-sugar tests. This led to a broad program in which each piece of equipment on the floor is examined on a monthly basis to see if anything on it needs to be replaced, fixed, or simply greased.

The trust factor
The staff was pleased with the initial results from the program and began suggesting more systemic changes to reduce noise. This led to a new system of rounding designed to anticipate patient needs. “The idea is that if you anticipate the patients’ needs, they will be less likely to ring,” said Mercier, who has been with Montefiore for 24 years.

More frequent rounding creates a virtuous circle. Patients are told by the nurse when he or she will be back (usually an hour on Mercier’s floor), and trust begins to be established. “Patients will usually wait for the nurse to return because of that trust factor,” Mercier said.

Of course, the goal is not to completely eliminate noise. But by reducing ambient sounds, nurses gain a more pleasant working environment, can better concentrate on the task at hand, and can more easily hear a patient monitor sounding an alarm.

Mercier said she does not have any personal research to suggest that noise reduction programs can help eliminate medical errors, as some have suggested (Susan Mazer, “Stop the Noise,” March/April 2005, Patient Safety and Quality Healthcare). Still, it stands to reason. “Personally, I am someone who has trouble concentrating with a lot of noise,” said Mercier. “If I’m doing anything I need to focus on, I need quiet. I think noise reduction gives you the opportunity to better focus on what you’re doing.”

There is little question that patients benefit from lower noise levels. When Mercier visits patients’ rooms on her rounds, they often voice their satisfaction with the quieter ward, especially those who have recently stayed at a louder facility. Not surprisingly, the SHHH program has been rolled out to all of the medical floors at Montefiore, and Mercier is working on an e-learning module that will be posted on the hospital’s intranet. The goal is to enable other departments in the 1,100-bed teaching hospital to learn from, and hopefully emulate, the program.

Quiet, please
Below is a list of potential noise-reduction actions gathered from Montefiore and a variety of Internet articles on hospital noise reduction.

• Lower paging system volume
• Set medical staff pagers to vibrate
• Encourage staff to speak quietly
• Reduce nursing calls with more frequent rounding
• Arrange for X-rays to be performed before midnight or after 6 a.m.
• Install sound absorbing ceiling tiles
• Carpet hallways
• Decentralize nursing stations
• Purchase bedside monitors with volume controls
• Encourage staff to give nursing reports in enclosed areas
• Implement an equipment maintenance program to quiet mobile machines
• Close patient doors to keep out noise from the hallway
• Encourage nurses to cover the speakers on IV pumps when changing IV bags
• Ask medical staff to wear soft-soled shoes
• Offer headphones to patients for TV watching
• Exchange pill crushing machines with quieter individual grinders
• Pad the sides and bottoms of bins designed to catch pneumatic tubes
• Replace noise roll paper towel holders with quieter folding-towel dispensers
• Cushion the bottom of metal chart holders with rubber pads
 
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