Evidence to change practice: creating a restful hospital environment for nurses and patients

Conducive environments reduce sleep disturbances and improve sleep quality: a quality improvement project

AIM

The current implementation project aimed to improve patients' sleep quality in a hospital by implementing targeted interventions to reduce sleep disturbances.

METHODS

The Silent Night project was implemented in two general units of an academic tertiary hospital. The project comprised three phases: preimplementation, implementation, and postimplementation. Patient surveys were administered to obtain patients' perspectives on the sources of noise disturbances at night. Noise-monitoring machines were installed in two wards to obtain objective data on noise levels at night. Concurrently, data were collected on noise-generating activities that were observed.

RESULTS

The overall quality of sleep reported by patients improved by 17% (from 73.5 to 88.9%). Patients' survey reported reduced noise disturbances from direct care activities, environmental noise and medical equipment alarms. The mean noise level in the orthopedics unit reduced significantly from 57.04 to 55.22 dB with a corresponding decrease in noise generating activities by 60% (from 362 to 144). In the geriatric unit, the mean noise level increased from 51.36 to 53.12 dB but is within the National Environmental Agency's permissible noise level of 55 dB even though the noise generating activities reduced significantly by 92.2% (from 954 to 74).

CONCLUSION

The 'Silent Night' project has successfully reduced noise disturbances generating from environment and nursing care activities and improved patients' sleep quality in the hospital. Sharing sessions regarding sources of noise and the 'Silent Night' poster promoted the awareness of noise disturbances in healthcare professionals, visitors, and patients.

Quiet Time Improves the Patient Experience

BACKGROUND

A quiet environment promotes rest and healing but is often challenging to provide in a busy acute care setting. Improving quiet in the hospital for designated hours improves patient satisfaction. Such efforts have typically been the primary responsibility of the nursing staff.

LOCAL PROBLEM

Two medical units with consistently low Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS) "always quiet" scores were chosen for this study.

METHODS

A multidisciplinary team used Lean methods and the Model for Improvement to test interventions for quiet time (QT) and used HCAHPS "always quiet" scores as the primary outcome measure.

INTERVENTIONS

The team instituted nighttime and afternoon QT supported by rounding and scripting, dimming lights, lowering staff voices, offering a sleep menu at night, and replacing noisy wheels.

RESULTS

Quiet scores improved on both units after 11 months.

CONCLUSIONS

Noise in hospitals is often beyond the scope of nurse-driven improvement; however, a QT protocol led by nurses, developed by multiple stakeholders, and focused on changing expectations for quiet can lead to measurable improvements in patient perception of quiet.