Monday, April 7, 2014

The A-B-ZZZZ's of Quiet at Night

Do you get enough sleep? If you do, chances are you haven’t been sleeping in a hospital bed.

Do you know what it’s like trying to sleep in a hospital? One group of curious hospital staff did; they recorded the sounds that a patient would hear in a typical MedSurg room between 9:00 p.m. and 6:00 a.m. The recording was put on a DVD, and each staff member took a copy home to play in their own bedrooms that night.

It was a disaster.

The staff were appalled and disappointed at the level of noise in their hospital—they wondered how their patients could possibly get any rest!

Quiet matters. Quiet is necessary for healing, essential for rest, and related to everything that hospitals represent.

Consider This:

Staff Noise

Surveys show that the highest decibel level in a hospital is recorded during shift change, so be aware of human noise at that time. Here are some suggestions for simple noise control.

Install a tasteful visual reminder, like the Yacker Tracker. The light shouldn’t be red when people are in bed!

Have a noise hotline that patients can call (instead of using the call buttons) when things get too rowdy.

Set alarms to ring at the nurse’s station instead of a patient’s room.

If you’re feeling ambitious, brainstorm ways to reduce food tray ‘rattle’ and similar noises.

If you designate “Rest” or “Evening Quiet” times (and you should), make sure to dim the lights on the floor so there’s no confusion for new arrivals. Posters (placed prominently during quiet hours) and public announcements made from overhead speakers will also help increase awareness.

Mechanical Noise

A certain level of mechanical noise in hospitals is unavoidable. All staff should be empowered to fix (if they can) or report to Maintenance (if they can’t) any noise interfering with patient comfort and tranquillity. Create a list of the major mechanical noise-offenders on your floor, and have them fixed one at a time. Better yet, create a never ending “Job Jar” by writing down all the things that need fixing and putting the pieces of paper in a big glass (or plastic) jar at the nurse’s station.

Some noise may not be easy to predict. For example: Check high traffic doors, and install bumpers if necessary.

One of the biggest noise offenders is trash compactors located near a patient’s room; it’s fairly easy to have them moved elsewhere.

The Mood

I’ve found that the traditional approach to improving “Quiet” scores is to stop needless mechanical noises, and start a “HUSH” (Help Us Support Healing) or “SHHH” (Silent Hospitals Help Healing) campaign. That’s a good start, but here’s the thing:

The only reference a patient has for ‘quiet at night’ is the solitude of their home.

Patients need to understand that a hospital bed is not like their bed at home, not even close. Staff should be managing patient expectations right from Admitting so that patients have a realistic idea of their nighttime experience. “Quiet” is different at hospitals; because treatment sometimes occurs at unusual hours, patients should be warned that they will hear sounds of care during the night.

Remember Domino’s Pizza? They had a guarantee: if it wasn’t delivered within thirty minutes, it was free. We had confidence in that promise, so it didn’t really matter if it was five or ten minutes late, because we could expect delivery in half an hour—or we could expect a free pizza. Domino’s managed our expectations by giving us a guideline, and that’s exactly what you need to do with your patients.

Try telling your patients:

“We are making every effort to perform those activities with the minimum amount of noise.”

“I know you are used to the quiet solitude of sleeping in your home – but the hospital is a little different.”

The Take-Away Stop complaints before they start by educating patients and creating reasonable expectations.

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