Let’s not be quiet about noise reduction ideas

There’s a lot of talk about noise in hospitals lately. Just last month, the Denver Post published an article about a trend developing in hospitals in that region: real attention to noise reduction.

The Rocky Mountain region is not alone in recognizing the seriousness of this seemingly simple issue. Recent research shows that noisy hospitals may increase the length of stay for patients and the chance for medical errors by staff, according to Ilene Busch-Vishniac, a sound-engineer professor at Johns Hopkins University who has studied the issue.

Her two-year study, published in 2005, showed that daytime hospital sound levels have increased from 57 decibels in 1960 to 72, equivalent to a noisy restaurant.

Here’s the difference: If you go to a bar, a bistro or a diner, you expect noise to be part of the experience. That’s not the case when you come to the hospital. Moreover, the issue is not just about amenities; excessive noise is being linked to safety and quality.

“There is an incredible amount of noise in hospitals,” said Busch-Vishniac, who said noise ranks among the top five complaints listed by patients and staff. “There appears to be a link between noise and the speed of which people heal and medical errors.”

In the coming weeks, we’ll examine the noise issue — and seek your solutions and suggestions — more closely. Remember the saying: Patients not only heal; they hear.

Patients hear as well as heal

It’s ironic, isn’t it? When you’re hospitalized, everyone tells you to get some rest. But we all know it’s hard to get a good night’s sleep (or an afternoon nap) in a hospital. Some of that is the nature of providing healthcare: tests are scheduled, assessments must be made, IVs need to be started, vitals must be checked and meds given.

But some of the noise — the part that patients really don’t understand — is avoidable. Things like loud talking and laughter in the evening. Unanswered phones, with the ring-tones set at maximum. Carts that squeak and clipboards that snap. Add to that frequent overhead paging and the possibility of a roommate with late-hour TV habits and you’ve got the recipe for a sleepless night. That’s hardly going to make for a satisfied patient.

Noise is an issue at Backus Hospital, as it is for hospitals nationwide. Here at Backus, fewer than half (46.5%) of inpatients who completed our patient experience survey last quarter answered “always” to the question: How often was the area around your room quiet at night?” More telling, that score placed Backus in the 56th percentile of 917 hospitals in the NRC+Picker database — well below other areas, where we score in the upper 90th percentiles. That means 44% of those hospitals do a better job than we do.

Our patients notice. Here are some actual comments from our HCAHPS survey. Patients were asked to name “one thing they would change about the hospital”:

• “Have less noise in the evening”
  
• “Would want a quieter room”
  
• “Nurses’ station in very early morning hours should be as quiet as need be, so as not to disturb patients with laughter, etc.”
  
• “More quiet nights”

(You can see all the comments on the Backus Intranet: Click Patient-Centered care under the Quick Links, and then “The Patient’s Voice” link. To read an interesting Los Angeles Times article about hospital noise, visit our blog at backusblog.blogspot.com and click on the link provided with this story. )

When it comes to always providing a great patient experience at Backus, remember: Our patients not only heal; they hear.

Joint Commission to visit any time now

For the past several months the Backus Hospital's weekly employee newsletter has published a “Focus on Safety” series to raise awareness about patient safety.

Although patient safety should be at the forefront of everyone’s mind year round, now is the time to raise issues and ask questions – the Joint Commission is scheduled to show up unannounced at any time beginning now.

In preparation for the Joint Commission visit, the hospital will undergo a “mock survey” Feb. 6-8.

As a refresher, here are the 2007 Joint Commission Patient Safety Goals:

• Improve the accuracy of patient identification
• Improve the effectiveness of communication among caregivers.
• Improve the safety of using medications.
• Reduce the risk of health care-associated infections.
• Accurately and completely reconcile medications across the continuum of care.
• This includes providing a complete list of the patient’s medications and communicating to the next provider of service when a patient is referred or transferred to another setting, service, practitioner or level of care within or outside the organization. The complete list of medications is also provided to the patient on discharge from the facility.
• Reduce the risk of patient harm resulting from falls.
• Encourage patients’ active involvement in their own care as a patient safety strategy. Define and communicate the means for patients and their families to report concerns about safety and encourage them to do so.
• The organization identifies safety risks inherent in its patient population, including identifying patients at risk for suicide. [Applicable to psychiatric hospitals and patients being treated for emotional or behavioral disorders in general hospitals).

For more information go to jcipatientsafety.org


Anyone with any questions about the National Patient Safety Goals, or suggestions to improve patient safety at Backus, is asked to call or email Mary Bylone, Assistant Vice President, Patient Care Services and Patient Safety Officer, ext. 2771, or Joe Hughes, Director of Quality Improvement, at ext. 2345.

New pediatric emergency kits reduce possibility of dosage error

Members of the code 8 committee have devised a new process to make it safer to give medications in pediatric emergencies. The newly revised pediatric emergency kits will improve patient safety during pediatric code situations, Backus staff members say.

Eric Arlia, Director of Pharmacy Services at Backus, said previously in a pediatric emergency, medications such as dopamine, dobutamine, and lidocaine would need to be mixed specifically for each code situation. Dosages were calculated differently for patients of different sizes and ages, which could potentially result in a calculation and mixing error.

In the new system, the medications are mixed the same way no matter what the size of the child. The drugs (mentioned above), as well as epinephrine and norepinephrine, are pre-mixed and administered according to an infusion rate chart. There are no calculations or mixing needed, providing a faster way to administer medications with less chance of error.

Debbie Dolan, RN, Clinical Director of A-3, where the majority of pediatric patients are admitted, said not having to calculate doses in the midst of an emergency will certainly help pediatric patient safety.

“This is certainly going to help ensure that our pediatric patients receive the right medication, at the right dose at the right time,” she said.

Peter Shea, MD, Medical Director at Backus, agrees.

“The ability to provide a more precise, accurate dosage will greatly increase patient safety in these situations,” he said.

The revised emergency kits are in compliance with Joint Commission standards. However, the standard requirements did not specifically explain how to design such a system, which is where the committee’s ingenuity proved useful.

Mr. Arlia explained that pediatric emergencies can be very tense, and he believes the new emergency kits will help make these situations easier.

“This new system will help both physicians ,patients and staff by allowing medications to be dispensed faster and with less chance for error,” he said.

Medication safety is a major part of the commission's patient safety goals. Backus will receive an accreditation visit later this year. A mock survey will be held Feb. 6-8. Anyone with any questions about patient safety goals, or suggestions to help Backus improve patient safety, can call Mary Bylone, Assistant Vice President of Patient Care Services and Patient Safety Officer, at ext. 2771, or Joe Hughes, Director of Quality Improvement, at ext. 2345.

Prompt action by employee spurs safety change

A Backus Hospital staff member recently recognized a potential patient safety issue and was the driving force behind a hospital systems change that will no doubt benefit patients.

The Critical Care Unit staff member, who asked not to be identified, noticed a potentially serious patient safety issue related to Medication Reconciliation forms and post operative procedures.

Here is what transpired:
? A patient returned from surgery with an outdated medication reconciliation form.
? The form was completed renewing medications that were not current.
? The staff member caught the problem before medications were administered, and alerted her clinical director, Debra Furtado, RN.

Ms. Furtado said the staff members actions have resulted in a change that will benefit patient safety. She said prior to the incident, when patients went from surgery to an inpatient unit, it was expected that the inpatient unit coordinator would print up and send the most current medication reconciliation form with the patient’s chart. That form was to be utilized by the surgeon during the post operative ordering of medications.

“This is an exceptionally unstable time for patients returning to the CCU from surgery with medications being of the utmost importance,” Ms. Furtado said. “If the order form in the chart was not printed up and an old, outdated version was left sitting in the chart for the surgeon to review, potential danger was just a step away.”

Under the new protocol, which is the direct result of the staff member’s actions and her recommendations, PACU simply prints the most current form in that department and makes it available to the surgeon when orders are written. PACU Clinical Director Shelbye Maynard, RN, gladly agreed with the plan and implemented the change in her department.

The staff member also recommended that Nursing Informatics be alerted to the situation, which Ms. Furtado did.

Karen Long, RN, Vice President and Chief Nursing Officer, praised the staff member for her due diligence and eagerness to alert the appropriate parties.

“This is a perfect example of the benefits of checking and double checking every step in the process of administering medication to our patients, and taking action to address a patient safety issue,” Ms. Long said. “This staff member did exactly the right thing for our patients. Patient care has been improved due to her attention to detail and willingness to communicate.”

Peter Shea, MD, Medical Director, encouraged all Backus staff to pay attention to patient safety issues in their department, and if issues are identified, think about how other departments might be involved to reduce the chances of the problem popping up again.

“In order to improve patient safety, we must push for systems-wide change,” Dr. Shea said. “That can’t happen if we aren’t thinking outside the box, and communicating with our colleagues in other departments. In most cases, more than one department is involved and need to be brought into the loop.”

Mary Bylone, RN, Assistant Vice President, Patient Care Services, said this is the perfect example of identifying and correcting a systems issue that put good people at risk for failure.

Ms. Bylone added that medication safety and communication among caregivers are important components of the Joint Commission on Accreditation of Healthcare Organization’s Patient Safety Goals. Anyone with questions about the upcoming JCAHO visit, or suggestions to improve patient safety at Backus, should call Ms. Bylone, who is the hospital’s Patient Safety Officer, at ext. 2771, or Joe Hughes, Director of Quality Improvement, at ext. 2345.