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Patients in Acute
Care
Group B
Evidence Based Practice
Presentation
Introduction
Problem: That current quiet time implementation does not decrease noise levels
on critical care units.
Goal: Identify methods to best decrease noise levels within critical care units.
PICOT
What is the best method, protocol, or guideline to implement quiet time once
every 24 hours for adult patients on critical care units as compared to current
practices that are ineffective in decreasing noise levels?
Local - No policy exists within the ICU. However, hospital policy is for
quiet hours from 2000-0600 (overhead announcement, signs, and
reduced lighting in some areas)
State - No state policy for quiet time within ICUs. Standard practice is
a period of quiet time between 2200-0600 and/or 1400-1600 with
signs posted and education of visitors and medical personnel.
-Long duration
Summary of Limitations
-Patient interaction
b. Study referenced:
Yacker Tracker
EBP Recommendations
3. In order for quiet time to be successful, incorporate quiet time
training into continuing education credits for staff and add the
enforcement of consistent quiet time as a component of the unit managers
position.
a. Study referenced:
i. Maidl et al. (2014): requirement for medical staff education
regarding time and method for quiet time implementation will
increase awareness and correct implementation of quiet time
b. Study referenced:
i. McAndrew et al. (2016): education for staff promotes the
successful implementation of consistent and evidence-based
practices to reduce noise during quiet time
Timeline of Implementation: Day 1
2. Print and hang signage around the unit. Place in staff rooms, on
the entrance of the unit, and outside of patients doors to remind
hospital staff and visitors of quiet time. Place Yacker Tracker at
nurses stations.
Timeline of Implementation: Day 1 -
Weeks
3. Day 1-Weeks: Team leader educates nursing staff about quiet time protocol
at staff meetings and morning huddle. This education would occur every
morning until all of the nurses on the unit received this initial education.
4. Day 1-Weeks: The nurse would then provide education to patients and
visitors on admission and as needed on the quiet time protocol and how it is
beneficial to the patients care.
Family dissatisfaction
If the family is asked to leave
If the family is not allowed to visit
Families feel like theyre being excluded from care
Cost of implementation
Patient safety
Low lights
Decreased alarm volume
Benefits
-Noise level will not exceed yellow indicator on Yacker Tracker for
duration of quiet time.
-Nurse will not disturb patient more than once unless medically
necessary during the designated quiet time.
-Nurses will attend one training seminar about QT protocol every three
months.
-Problem: Implemented quiet time in critical care units did not reduce
noise levels
-The initial cost of starting quiet time will eventually save the hospital
money
The best bridge between despair and
hope is a good nights sleep.
-E. Joseph Cossman
References
1
Harrington, Michelle, and Kathleen Deleskey. "Shh! Quiet Time in the ICU." Nursing
Management (Springhouse) 46.5 (2015): 21-23. Web.
2
Johnson, D. W., Schmidt, U. H., Bittner, E. A., Christensen, B., Levi, R., & Pino, R. M. (2013, July 4). Delay of transfer from the
intensive care unit: A prospective observational study of incidence, causes, and financial impact. BioMed Central, 17(4).
doi:10.1186/cc12807
3
Konkani, A., Oakley, B., & Bauld, T. J. (2012). Reducing Hospital Noise: A Review of Medical
Device Alarm Management. Biomedical Instrumentation & Technology, 46(6), 478-487. doi:10.2345/0899-8205-46.6.478
4
Maidl, C., Leske, S., & Gracia, A. (2013, July 10). The Influence of Quiet Time for Patients in
Critical Care. Sage Journals, 23. doi:10.1177/1054773813493000
5
Mcandrew, N., Leske, J., Guttormson, J., Kelber, S., Moore, K., Dabrowski, S. "Quiet Time for Mechanically Ventilated Patients
in a Medical Intensive Care Unit." Western Journal of Nursing Research 38.10 (2016):
1374-375. Web.
References
6
Park, M. J., Yoo, J. H., Cho, B. W., Kim, K. T., Jeong, W., & Ha, M. (2014). Noise in hospital
rooms and sleep disturbance in hospitalized medical patients. Environmental Health and
Toxicology, 29. doi:10.5620/eht.2014.29.e2014006
7
Riemer, H. C., Mates, J., Ryan, L., & Schleder, B. J. (2015). Decreased Stress Levels in Nurses:
A Benefit of Quiet Time. American Journal of Critical Care, 24(5), 396-402. doi:10.4037/ajcc2015706
8
Tainter, C. R., Levine, A. R., Quraishi, S. A., Butterly, A. D., Stahl, D. L., Eikermann, M., Lee,
J. (2016). Noise Levels in Surgical ICUs Are Consistently Above Recommended
Standards. Critical Care Medicine, 44(1), 147-152. doi:10.1097/ccm.0000000000001378
9
Watson, J., Kinstler, A., Vidonish, W. P., Wagner, M., Lin, L., Davis, K. G., Daraiseh, N. M.
(2015). Impact of Noise on Nurses in Pediatric Intensive Care Units. American Journal of
Critical Care, 24(5), 377-384. doi:10.4037/ajcc2015260