NOISE ASSESSMENT ON INPATIENT UNITS Presenters: Nancy M. Daraiseh - - PDF document

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NOISE ASSESSMENT ON INPATIENT UNITS

Presenters: Nancy M. Daraiseh PhD, Principle Investigator Angela Kinstler MSN, RN, CNL, Co-Investigator Additional Contributors: William Vidonish III MBA, BSIE, Co-Investigator Michael Wagner PhD, Co-Investigator Li Lin, MS, Statistician

Background

• CCHMC parent satisfaction surveys indicate

that parents perceive the area around their child’s room as not always quiet.

• Noise levels at CCHMC (baseline noise w/o

alarms or patients) = 40 decibels dB(A)

– The EPA and the AAP recommend hospital interiors 45 (dB(A)).

• Noise Effects on Health
• Patients

– delayed onset of sleep – decreased sleep duration – increased disruption of sleep – cardiovascular changes – increased pain medication – extended length of stay – re-hospitalization

• Staff

– Increased risk for safety events – near misses – decreased job performance – fatigue – irritability – noise-induced hearing loss

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Objective:

• Describe recommended noise levels in the

healthcare environment and impact of noise

• n staff health..

Magnet Components

• New Knowledge, innovations &

improvements

• Exemplary Professional Practice

Overall goal:

• By prospectively measuring noise exposure on

inpatient units we can identify:

– major sources of noise – levels of noise exposure – associations with health indicators

• These are important steps to developing and

implementing practice changes that can reduce the

• ccupational burden of noise on inpatient units for

patients, families & staff.

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Specific Aims

• 1. Determine the prevalence of excessive
• ccupational noise exposure (decibel, duration) on

inpatient units (provider & patient).

• 2. Determine worker, patient, and environmental

characteristics that contribute to excessive

• ccupational noise exposures on inpatient units.

What is involved?

• Phase I

– The focus is to involve members from each unit to form a core team to develop the research plan for this study. – This team was responsible for oversight of the study and recruitment on their respective units.

What is involved?

• Phase II

– The study involves measuring levels and sources of noise on all inpatient units using dosimeters worn by staff and attached to patient beds – Six, 4-hour shifts for each unit – Observers log sources of noise at 5-minute intervals – Staff wear heart rate monitors to assess health impact – Student observers carried out data collection

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• RESULTS

Demographics

• 19 Units including Base, Liberty & College Hill
• 5 non-participating units
• Demographics:

– Total 89 nurses*, 88.8% female – Average age = 36 ± ± ± ± 9.8 (Range 23-63) – Average experience = 8.1 ± ± ± ± 7.9 years (Range 0-37) – Average BMI = 27.4 ± ± ± ± 5.7 (Range 19-41)

*7 nurses repeated observations

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Descriptive Data

• 19804 noise observations
• 16535 heart rate (HR) data points
• Baseline HR 89.9 ±9.2 (40-191)
• Stress (0-100)

– Pre 26.7 ± 26.1 – 2hr 28.3 ± 26.3 – Post 20.4 ± 24.3

Noise exposure at the staff level

• The average observed noise level was 76dB ± 9.2

(45-111).

• The average noise level in 10 out of 15 units (66.7%)

exceeded the “excessive” noise threshold of 75dB.

– Overall: 54% – College Hill: 53.4% – Base: 55.6%

*noise levels >90dB occurred at 4.9% of the time

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Noise Level Distribution

83.4 79.6 79 78.8 78.7 76 77 78 79 80 81 82 83 84

P3S A6S A6C P3N B5CA Mean Noise Level (dB)

Units with the Highest Noise Levels

Sources of Noise

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Sources of Noise Defined as “Other”

• In descending order

– General ambient noise when no other sound was present (e.g. air conditioning) – Office equipment (fax/copier/printer) – Keyboard strokes or clicking of the mouse – Things falling on the floor – Running faucet or flushing toilet – Sneezing – Music – Running sink – Trash can (throwing away items, kicking, etc.) – Chest tube drainage systems – Chairs scooting across the floor

Noise Location Activity

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Noise Sources > 75dB Noise Location > 75dB Activity when noise > 75dB

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10.0 - 40.0 40.0 - 70.0 70.0 - 100.0 100.0 - 130.0 130.0 - 160.0 160.0 - 190.0 190.0 - 220.0 220.0 - 250.0 250.0 - 280.0

Heart Rate

Heart Rate Distribution

Units with the Highest Average Heart Rate

97.3 95.5 92.2 91.4 88.1 82 84 86 88 90 92 94 96 98 A7C1 B4 A6C A3S B5CA Average Heart Rate

Noise & HR

All nurses

• The average heart rate increased 0.8% when noise levels

>75dB.

• The average heart rate increased 2.4% when noise levels

>90dB.

Nurses with baseline heart rate 100

• 10.1% of nurses’ HR was >100
• The average heart rate increased 1.0% when noise levels

>75dB.

• The average heart rate increased 2.5% when noise levels

>90dB.

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Noise level comparison between nurses and patients

• The mean patient’s noise level 63.6dB was

significantly lower than the mean nurses’ noise level 76dB.

Conclusions

• Staff on inpatient units are exposed to high noise levels
• ver 50% of the time
• Many sources of noise are preventable (i.e. Staff

conversations)

• Noise levels have a significant association w/ HR but not
• n self-reported stress and tachycardia
• Recommendations of 45dBA may be unattainable in

some settings

Limitations

• Baseline HR
• Sources of noise not unit-specific
• Number of shifts assessed per unit

– noise & shift – noise & time of day

• Lack of patient variables
• Subjectivity in documentation

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Next Steps

• Units have the area-specific data to begin

quality improvement projects that can reduce

• verall noise to acceptable levels
• Unit-specific assessments can allow for in-

depth understanding of noise sources

• Incorporating patient-specific data and/or
• utcomes in noise assessments

Questions?