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Patient care units are as noisy as jackhammers

Patient Safety Monitor Alert, February 25, 2004

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If you think your care units allow patients to get a good night's sleep, try spending the night in one. That's exactly what nurses at the Mayo Clinic did when they tried to determine why post-surgical patients weren't getting enough rest.

The nursing team placed noise dosimeters in three empty patient rooms during a night shift without the night staff's knowledge. They also had team members spend the night in a semiprivate room that contained all of the equipment and monitors typically used during a thoracic surgery patient's stay.

The results were surprising: Although the unit was generally quiet, peak noise levels during shift changes rivaled the noises produced by chainsaws or a jackhammers, the nurses found. Their results appear in a case study published in the February issue of American Journal of Nursing (Vol. 104, No. 2).

"We got an earful," says Cheryl Cmiel, the lead author of the paper. The noisiest times were during the morning shift change at about 7 a.m., and during the 11 p.m. shift change.

"Adequate sleep is important to the healing process, and sleeping in the hospital is notoriously difficult," says Cmiel. "Our continuous improvement team wanted to find specific causes for the problem, and see what concrete steps we could take to help solve it."

As a result, the hospital made several "sleep-promoting" changes, including:

>> Moving staff reports at shift change to an enclosed room, instead of at the nurses' desk

>> Routinely closing doors to patients' rooms

>> Modifying cardiac monitor settings to allow for lower volumes in the patient rooms, but with additional alarms sounding at the nurses' station

>> Using flashlights instead of overhead lights when entering patients' rooms

"The first step is to survey patients and ask what noises are interfering with their sleep," says Cmiel says. "Problems in a given environment may be different from our experience, and noises patients find disturbing are not always apparent to nursing staff. But it's worth the effort; reductions of even a few decibels can improve sleep and help patients get the rest they need to heal."

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