ALWAYS Quiet Quietness of the Hospital Environment
Vikki Choate, MSN, RN, CCM, RN-BC, CPHQ Studer Group Coach Nashville, TN
May 14 - 15, 2013
Learning Objectives At the end of this session, participants will be able to: Define the physiological and psychological effects of hospital noise on patients Recall three best practices to decrease hospital noise
Describe how Daily Huddles, Hourly Rounding®, Bedside Shift Report, and Nurse Leader Rounding may be leveraged to improve HCAHPS ‘quiet at night’ results Copyright © Studer Group. Please do not quote, cite, or disseminate without Studer Group authorization.
Is It a Hospital or a Highway?
Alarms on monitors decibel level = 79
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Heavy truck traffic decibel level = 80
A Patient Perspective – Straub Foundation “If you have had the pleasure of a stay in the hospital, you know exactly what I mean. Patients rarely get any sleep. Every hour or so the overhead fluorescents flash on as a nurse makes his or her rounds. Pagers sound, machines beep, alarms blare, and cart wheels squeak. Room doors are open and the sound of staff chatter filters in. One eventually leaves the hospital exhausted.”
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Hospital Noise
Unnecessary noise is “the most cruel absence of care which can be inflected either on sick or well.” Florence Nightingale, 1859, Notes on Nursing Copyright © Studer Group. Please do not quote, cite, or disseminate without Studer Group authorization.
Healthcare Flywheel®
Bottom Line Results
Prescriptive To Do’s Daily Huddles Bedside Shift Report Hourly Rounding℠ Leader Rounding on Patients
Improved HCAHPS results on ‘Quiet at Night’ question
Purpose, worthwhile work and making a difference
SelfMotivation
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®
Rev 4.8.11
Execution Framework Evidence-Based LeadershipSM Foundation STUDER GROUP®: Objective Evaluation System
Leader Development
Aligned Goals Implement an organizationwide staff/leadership evaluation system to hardwire objective accountability
Create process to assist leaders in developing skills
Must Haves®
Performance Gap
Aligned Behavior
Agreed upon tactics and behaviors to achieve goals
(Must Haves®)
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Re-recruit high and middle/solid performers Move low performers up or out
Standardization Accelerators
Aligned Process
Processes that are consistent and standardized Process Improvement PDCA Lean Six Sigma Baldrige Framework
Software
Organizations Coached by Studer Group Outperform the Nation across HCAHPS Composites
New Update! 3Q11-2Q12
Studer Group Difference over Non-Partners in National Percentile Ranking Overall Rating Willingness to Recommend Pain Management Nursing Communication Communication of Medications Clean and Quiet Discharge Instructions Responsiveness of Staff Doctor Communication
19 12 16 20 17 5.5
percentile points higher
17 10
5
0 5 10 15 20 Studer Group Difference over Non-Partners in National Percentile Ranking
25
Source: The graph above shows a comparison of the average percentile rank for Studer Group Partners that have received EBL coaching since Oct 2008 and non-partners for each composite; updated 5.2.13 using 3Q11-2Q12 CMS data. Copyright © Studer Group. Please do not quote, cite, or disseminate without Studer Group authorization.
HCAHPS – The ‘Quiet’ Question During this hospital stay, how often was the area around your room quiet at night?
Never
Sometimes
Usually
Always
Do we really care only about night time noise?
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Did You Know? World Health Organization recommends that hospital noise levels should not to exceed 30 db Studies show noise levels in hospitals may range from 53 to 117 db Peak noise levels of a busy surgical floor can exceed 95 db
ICUs usually have the highest sustained levels of noise with an approximate average mean equivalent sound level of 56 db Source: Ann R Coll Surg Engl. Noise pollution on an acute surgical ward. 2008 Mar;90(2):136-9. Copyright © Studer Group. Please do not quote, cite, or disseminate without Studer Group authorization.
Why ‘Quiet’ is Important Did you Know that noise? Increases stress and anxiety levels, escalates fear Elevates cortisol production which increases blood sugar levels and decreases immune responsiveness Causes sleep deprivation which can lead to mood swings, confusion, or delirium Increases heart rate and blood pressure Increases gastric acid levels which give rise to nausea, ulcers, and GERD Increases susceptibility to infections …..and this goes for health care workers as well! Source: Nurs Adm Q. The effects of hospital noise. 2010 Oct-Dec; 34(4): 327-33. Copyright © Studer Group. Please do not quote, cite, or disseminate without Studer Group authorization.
Noise Impacts Critical Communication Noise jeopardizes important communication between patients, families, and healthcare workers Miscommunication may leads to mishaps Mishaps may lead to errors Errors may have profoundly negative effects on our patients and their families
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What We Say Matters Use key words on admission to manage patient’s expectations around noise and rest Develop key words to use proactively during times of construction or renovation Set expectations for key words to be used by staff
Adapt key rounding questions for leaders to validate effectiveness of ‘quiet’ tactics
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Driving Improved ‘Quiet at Night’ Results
Not new…..better! Daily Huddles Hourly Rounding® Bedside Shift Report Nurse Leader Rounding on Patients
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Daily Huddles Develop ‘quiet at night’ goal
Engage staff to identify strategies to reduce noise Incorporate goal and tactics as standing huddle agenda Reward & recognize or coach to gaps in performance Update staff with results regularly
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Bedside Shift Report Develop daily rest plan with patients Note plan on patient communication board Review effectiveness of plan at
each report, adjust as indicated Use key words ‘quiet’, ‘rest’, and ‘healing environment’
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Hourly Rounding® Offer ‘quiet kits’
Add ‘Pumps’ to the 3 Ps and anticipate alarms
Close patient doors after rounds when safe Follow rest plan developed with patient Bundle care to avoid interruptions and noise Explain rounding at night is a standard of safe, quality care
Use key words ‘quiet’ and ‘rest’ Copyright © Studer Group. Please do not quote, cite, or disseminate without Studer Group authorization.
Nurse Leader Rounding on Patients Obtain specific feedback from patients Act on opportunities to improve Validate individualized rest plan and ‘quiet kit’ Use key words ‘quiet’, ‘rest’, and ‘healing environment Reward & recognize or coach to gaps in performance Share findings and trends during Daily Huddles
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A Case Study in Noise Reduction Mary Greeley Medical Center: • 220 bed regional referral center in Ames, IA • Quiet at Night HCAHPS outcome lagged
significantly behind comparative data • Many physical/mechanical noise issues addressed, however no movement in results • Needed new strategy to address the people aspect of noise
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A Case Study in Noise Reduction Developed HCAHPS Domain Teams
Formed ‘Blitz Team’ Established sustainability: • Leader Rounding on Patients for quiet • House Manager noise audits • Celebration & lessons learned
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A Case Study in Noise Reduction Implemented a ‘Quiet Committee’
Invested in signage, communication boards,
and elevator door skins
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A Case Study in Noise Reduction Installed noise monitoring devices
Visiting hour overhead message – “thank you for helping us maintain a quiet, healing environment for our patients Established standards for phone and TV volume, implemented Vocera etiquette Dimmed lights Closed patient doors Obtained pillow speakers for TVs Leaders modeled quiet behaviors
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A Case Study in Noise Reduction
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Confirm Learning As a result of this presentation, are we able to? Define the physiological and psychological effects of hospital noise on patients Recall three best practices to decrease hospital noise
Describe how Daily Huddles, Hourly Rounding®, Bedside Shift Report, and Nurse Leader Rounding may be leveraged to improve HCAHPS ‘quiet at night’ results Copyright © Studer Group. Please do not quote, cite, or disseminate without Studer Group authorization.
Thank You!
Vikki Choate, MSN, RN, CCM, RN-BC, CPHQ Studer Group Coach 207.607.2218
[email protected]
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