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August 31, 2018

How North Shore nurses tamed a noisy ICU

Daily Briefing

    Editor's note: This popular story from the Daily Briefing's archives was republished on Nov. 29, 2018.

    Noise levels in the ICU can affect everything from patient sleep to staff stress and concentration. That's why North Shore University Hospital in New York implemented a strategy that has successfully lowered noise levels, Jennifer Thew writes for HealthLeaders Media.

    Collecting baseline data

    Before making changes, nursing staff at North Shore University Hospital used a decibel meter to collect baseline noise level data around the unit. Over an eight-day period, they measured the noise levels surrounding the nurses' station, which serves as the unit's central hub and is shared by many providers, as well as by two patient rooms located near the nurses' station.

    The team shared the noise-level data with the entire staff and educated the ICU team and other departments on the benefits of enforcing established quiet times twice a day through meetings, journal club sessions, and unit-based in-services, Thew reports.

    Implementing quiet time

    Based on the data collected, the team identified two blocks of time when quiet hours should be in place: 3 a.m. to 5 a.m. and 3 p.m. to 5 p.m.

    During those times, ICU staff dimmed the lights, spoke in whispers, and reduced environmental noise.  

    The nurses also developed new rules for ICU staff to ensure that everyone participated in quiet hours, including:

    • Adjusting other ICU staff schedules to complete tasks before 3 p.m.—for instance, physical and occupational therapists see patients before quiet hours and clinicians complete daily teaching rounds before quiet time;
    • Creating lists of tasks nurses needed to complete before quiet time, such as administering medication, taking patients' vital signs, turning off televisions, and quieting mobile phones and pagers;
    • Creating brochures and signs for each unit to explain quiet time;
    • Reminding visitors of quiet time and reducing overhead paging on the unit;
    • Distributing sleep masks and earplugs; and
    • Upgrading smart-monitors in patient rooms and the central stations to reduce alarms, as well as adjusting monitor default settings.

    Peace and quiet in the ICU

    Six months after North Shore made the changes, there was a statistically significant reduction of noise in two ICU locations. The two busiest locations also experienced a noise reduction, thought those changes were not statistically significant, Thew reports.

    Overall, the peak noise levels at the ICU are 15 decibels lower during quiet time than before the changes were implemented.

    While the ICU lowered noise level, the team still has "opportunities for improvement," according Thew. To further reduce noise, the nurse staff are working on finding a new place and time for physicians and physicians' assistants to hold teaching sessions. They also plan to install automatic opening functions for easier emergency access at the rear entrance of the unit (Thew, HealthLeaders Media, 8/2).

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