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We use signage in our inpatient areas to remind everyone to help control the noise level.

As healthcare providers, we know that patients not only need proper care and treatment to get better but that they also benefit from a healing environment.  The environment can include having family and friends present at bed side to provide support, a pleasing space in which to heal, good nutrition, and adequate rest.   Adequate rest can be one of the more difficult areas for the healthcare team to provide.  We are constantly barging into the patient’s room, asking them to take more medications, getting vital signs, drawing blood, and asking questions - all of which help us to provide good healthcare, but all of those distractions distract from the patient getting good rest too.  It’s especially difficult for patients to rest in our non-private rooms.  In addition to the all of the distractions we put upon a patient, the patient also has to deal with the distractions of his roommates, their visitors, and the healthcare team entering the room to provide them good care too.

One of our targeted improvements this year is to reduce noise, and our patients' perception of noise, as a mechanism to improve the healing environment.  

What do our patients have to say about noise?

We looked at our data and patient feedback related to noise on our inpatient wards.  Each patient gets a survey after they are discharged and beginning in 2009, we started asking the question, "How would you rate the noise level of your room?"  Patients answer on a scale of 1 to 5 with 5 being excellent.  From October 2010 through February 2011, the percent of patients answering good, very good, or excellent ranges from 61 to 80; so while we are showing improvement in this area, we still have our work cut out for us.

John Johnson, patient on 5A, told us, "The loudest part of the day is during shift change, from my room I could hear everything.  Nurses should do shift change in a designated area away from patient rooms."

Where did we start?

We started with some of the obvious sources of noise - STAFF.  We purchased Yacker Trackers and are piloting them on a few of our wards.  The Yacker Tracker is a stop light device that measures noise levels and advances from green to yellow to red the louder it gets.  These are visual indicators to staff that they are speaking too loud or too many people are talking at the same time.  Mr. Johnson thought that the Yacker Trackers were a great visual reminder to staff and visitors to keep it down.  We've also posted signage on the wards reminding everyone to be quiet.  We talk about noise during our staff meetings and remind employees of our initiatives to turn the volume down.  Maggie Vargas-Agostini, Nurse Manger on 5A, thinks that the Yacker Tracker is a good start.

We've replaced noisy wheels on some of our equipment.  We've made changes to the way we deliver meals to decrease noise omitted from the food carts.  We restrict overhead announcements and are working to lower the overhead buzzer that is emitted during emergency announcements.  Through generous donors, we are able to provide comfort kits to patients that include ear plugs and sleep masks.  Angela, an RN, said, "It's a matter of perception, staff think that they are being quiet but the Vet thinks differently.  We need to think like the Veteran."

What’s next?

We’ll continue to work on our noise reduction efforts until we get it right.  It's an important initiative so that we can provide a proper healing environment for our patients.  Kim Manganiello, Nurse Manager on 5B, thinks we are headed in the right direction but still have work to do to ensure that all of our Veterans are satisfied.

If you are a visitor or patient, here are some tips.

Tips to keep it Quiet

• Place cell phones and pagers on vibrate. When you receive a call, take it to a private area where you will not disturb others.
• When visiting a patient, ask permission to close the door when leaving. Our heavy doors block a lot of noise from the hallway.
• Use your "indoor" voice. Don't shout and watch how loudly you talk.  Take those hallway discussions to other rooms.
• Lower the TV volume when you are talking to a patient rather than raising your voice to speak over it.
• If your loved one is in a non-private room, ask staff if you can take your loved one for walk or visit one of our common spaces to talk so that you’re not disturbing the other patients in the room.