Background: The PACU is an environment where patients wakeup slowly after receiving anesthesia. A quiet non-stimulating atmosphere is the preferred setting for these patients. Instead, patients often wake up to alarms, loud conversations, noisy equipment, and ringing phones. Studies show that high levels of noise have negative physical and psychological effects on patients, including: sleep disruption, increased stress, and decreased patient confidence in the competence of their caregivers (Miller, 2006). The Joint Commission cites noise as a potential factor related to medical and nursing errors, stating that ambient sound environments should not exceed the level that would prohibit clinicians from clearly understanding each other (TJC, 2004). Purpose: The purpose of this quality improvement project is to determine whether implementation of noise reduction strategies and staff education will decrease sound levels in the PACU and result in improved patient and nurse satisfaction. Methods: Noise Reduction Strategies ´ Yacker Tracker-noise monitoring device ´ Noise canceling devices- MP3 players, IPADÝs, ear plugs ´ Signage-HUSH posters inside and outside the unit ´ Staff awareness and education of noise levels and the negative effects of noise ´ Zoning- patient care and nursing areas Results and Outcomes: Pre-implementation environmental sound levels were consistently higher than recommended levels, as determined by Environmental Protection Agency guidelines for hospital noise levels in patient care areas. Both inpatients and outpatients were surveyed over a 4 week period; 124 patients completed the noise survey. PACU nurses were also surveyed, and 30 out of 33 nursing surveys were returned. Patients overwhelmingly reported that a quiet environment is important to them, while the majority of nurses (67%) stated that noise levels affected their delivery of care. The majority of patients surveyed (65%) stated they would have used a noise canceling device had it been offered to them, and most nurses (93%) indicated they would offer these devices, if available, to help alleviate noise levels. Post intervention survey results showed significant reduction in noise as perceived by the patients. Patients were receptive in using noise canceling devices as offered to them by staff members. Nursing satisfaction scores showed increase awareness of noise in the PACU environment. Implications for Practice: Various strategies can be utilized to reduce noise levels in the PACU. Education and visual cues are effective in increasing staff awareness of noise levels. Reduction of noise levels decreases anxiety for patients recovering from their surgical experience, and promotes staff satisfaction due to less distraction.
Mary Rachel Romero
Clinical Nurse IV, University of Colorado Hospital