• Implementation of a Quiet Time Protocol in the Neurosurgical Intensive Care Unit

      Payida-Ansah, Damata; Bundy, Elaine Y. (2021-05)
      Problem: Sleep disruption among critically ill patients is associated with detrimental health outcomes such as reduced immune and neuroendocrine function. In a large metropolitan hospital’s Neurosurgical intensive care unit (ICU), 80% of staff surveyed reported high noise levels which can contribute to environmental ICU sleep disturbances. In this ICU, the average sound level was measured at 55.96 decibels, exceeding the Environmental Protection Agency’s recommended daytime hospital limit of 45 decibels. Purpose: The purpose of this quality improvement project was to implement a Quiet Time protocol in a neurosurgical intensive care unit. The Quiet Time protocol was implemented as a practice change to create a quieter and more sleep-friendly environment by minimizing patient sleep disruption, Methods: A Quiet Time protocol was developed and implemented over 10 weeks in a 14-bed neurosurgical intensive care unit following a review of best practices and unit policies, and staff education. The protocol included reduced noise and light levels, and clustering patient care activities from 2:00 to 4:00 pm daily. Nurses completed a protocol audit form daily documenting patients’ demographic data, sleep status and adherence to the protocol. Nursing documentation compliance to the protocol was monitored weekly. Data was collected and tracked weekly via run charts. Unit sound levels were measured with a decibel meter before and during quiet times. Results: Nursing staff Quiet Time protocol compliance rose from 30.77% in Week 1 to 78.26% by Week 10 and with full protocol compliance, patients were reported as asleep 60% of the time. Of the staff surveyed post-implementation, 44% agreed and 44% strongly agreed (totaling 88%) that they would like to use the protocol frequently. Average noise levels from 3:00 to 4:00 pm dropped by 6 decibels from 59.4 dB pre-implementation to 53.3 dB during implementation. Conclusions: Quieter and less stimulating hospital environments can be achieved with Quiet Time protocols when adequate education, nurse buy-in and administrative support exists. Further quality improvement projects on how hospital environments and workflow can be modified to reduce ambient noise are necessary.
    • Implementation of Daily Quiet Time on a Postpartum Unit

      Stinefelt, Megan; Gourley, Bridgitte (2019-05)
      BACKGROUND: A lack of quiet time during their hospital stay can have multiple deleterious effects on patients. Studies have shown that patients are exposed to multiple interruptions by hospital staff and louder than recommended noise levels while they are admitted in the hospital. LOCAL PROBLEM: The unit leaders at one local community hospital in Maryland noticed that a lack of quiet time was a daily problem on their unit. INTERVENTION: The purpose of this project was to implement and evaluate the effectiveness of daily quiet time on a postpartum unit at a community hospital in Maryland. In this quality improvement project, daily quiet time was implemented during the hours of 1:30pm to 3:00pm. Lights on the unit were dimmed. Nurses and other staff stayed out of patient rooms unless it was medically necessary or by patient request. Data collection occurred from October 2018 to November 2018 and included observing and recording the number of times staff entered a patient room and timing how long they were in the room. RESULTS: Pre-implementation data collection occurred on four days and post-implementation data collection occurred on nine days. On average, staff interruptions to patient rooms were 5.18 pre-implementation and 1.30 post-implementation per 90 minutes (P < 0.001). On average, interruptions in patient rooms by staff lasted 4.09 minutes pre-implementation and 3.66 minutes post-implementation. CONCLUSIONS: Due to the overwhelming acceptance of this quality improvement project by the postpartum staff as well as other departments in the hospital and the observed decrease in staff interruptions to patient rooms, daily quiet time is a sustained intervention that has become part of the standard workflow on the postpartum unit at a local community hospital.
    • Implementing Quiet Time on an Acute Care Unit

      Brown, Janet L.; Edwards, Lori A. (2021-05)
      Problem: Hospitals are very noisy places, and the excessive level of noise has deleterious effects on patients. After discharge, patients often comment about the noise and rate their hospital stay poorly because of the noise. In 2019, nationally, 60.3% of patients stated that the hospital environment was always quiet. In the same year, on an inpatient, neuroscience, acute care unit on the east coast of the US, 45.1% of patients stated that the hospital environment was always quiet. Purpose: The purpose of this quality improvement (QI) project was to implement and evaluate the effectiveness of quiet time in an inpatient, neuroscience, acute care unit to achieve improved patient satisfaction. Methods: All staff were assigned a learning module on quiet time to be completed prior to implementation. Decibels were measured prior to and during quiet time each day. A quiet time checklist was used daily to ensure each element of quiet time took place. These elements included dimming the unit lights, closing each patient’s door, posting signs on the unit entrances to alert any visitors, limiting non-emergent bedside procedures, prohibiting over-head paging, and discussion with patients and visitors on admission quiet time. The survey Patient Survey on Noise During Hospital Stay was collected at discharge from appropriate patients to understand their feelings on quiet time and noise on the unit. Patient satisfaction data was analyzed, by date of discharge, for questions “Rate quietness of the hospital environment” and “Noise level in and around room.” Results: Results show decreased decibel levels during quiet time, a majority of patients stating they felt quiet time was effective and promoted a restful environment and varying patient satisfaction scores related to noise. Conclusion: Implementing quiet time on an inpatient hospital unit has a positive effect on lowering the overall noise on the unit during quiet time hours and providing patients a quiet, restful environment.