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THE EMPOWERED NURSE

Room (OR) noise for safety. Research indicates noise negatively Reducing Post Anesthesia Care
impacts staff and patients. This prompted perioperative organi-
zations to call for action to mitigate the effects of noise during Unit (PACU) Noise
OR critical times. Modern technologies, multidisciplinary team
and multi-information sharing, various noise-producing equip- Purpose: High noise levels contribute to numerous medical
ment and devices heighten the symphony of noise, making the errors. We sought to measure the effectiveness of a multi-inter-
OR more complex, stressful and unsafe environment. vention approach to reduce PACU noise, and specifically to de-
termine if the interventions impacted patient outcomes,
Strategy/Implementation/method: OR noise assessment satisfaction, post-operative narcotic usage, or decreased PACU
was conducted by measuring 60 OR noise levels at 4 feet perime- noise levels pre to post.
ter from OR table during the two critical times of surgery (30
surgical count and 30 anesthesia emergence). OR noise was Relevance/Significance: Literature concludes Post Anes-
measured using the National Institute for Occupational Safety thesia Care Unit (PACU) patients required more analgesia when
and Health (NIOSH) Sound Level Meter, an iPhone app. An ex- noise levels were higher, and in hospitalized neonates abnormal
ternal microphone was utilized and calibrated by a VUMC audi- brain/sensory and language development results from a noisy
ologist. We obtained anonymous multidisciplinary staff noise environment. In patients and health care workers, physiologic
perception via electronic survey to assess if noise was perceived (increased heart rate, blood pressure) and psychologic (sleepi-
as a problem. OR leaders, quality committee & key stakeholders ness, stress) changes are associated with increased noise levels.
were involved for collaboration and support of this project.
Based on synthesized noise reduction strategies from staff and Strategy/Implementation/Methods: Institutional Review
studies, a plan was designed for action. Board approval was obtained. Noise levels were measured in a
pediatric PACU using 4 calibrated dosimeters for two weeks pre
Evaluation/Outcome: Statistical analysis reveals OR noise and post interventions. Number of alarms on telemetry moni-
levels were median 68 dBA, maximum 87 dBA and peak of 106 tors, PACU/OR hold times, pain medication administration, pa-
dBA respectively. Staff estimated noise level during surgical tient and family perception of anxiety, and nurse perception of
count was 60 dBA and anesthesia emergence was 55 dBA, how- alarm fatigue were also recorded pre/post. Interventions in-
ever, actual noise measurements were 82 dBA (surgical count) cluded installation of HUSH curtains in test areas, nurse educa-
and 92 dBA (emergence), well above WHO recommendations. tion to adjust monitor alarm parameters specific to patient
Perceptions that the OR was too noisy were 60% of the respon- parameters and decreasing the QRS volume from 5 (default) to
dents while 47% felt noise causes stress and distractions. 2. A visual cue for staff conversations (Yacker-Tracker©) was in-
stalled to reduce noise levels.
Conclusion/Implication of practice: Nursing initiative with
multidisciplinary staff involvement to assess OR noise provides Evaluation/Outcomes/Results: The noise measurements
strong evidence for improving safe practice. Nurse driven practice were statistically significant. Noise measurements decreased pre in-
improvement initiatives empowers staff to seek and find answers to tervention to post at the nurses’ station (p=.016), in PACU bay with
clinical questions, ultimately, improving the quality of patient care. normal curtains (p=.016), PACU bay pre/post HUSH curtains
(p=.005). The float nurse dosimeter measurements indicated no
significant reduction (p=.529), with pre measurements of maxi-
mum 98.8195dBA, peak 99.5072dBA, mean 66.9489dBA and post:
maximum 99.1132dBA, Peak 100.5522dBA, and mean 66.8356 dBA.

Conclusions/Implications: The interventions of HUSH
Glendyle Levinskas, BSN, RN, CNOR curtains, customizing telemetry monitor alarm limits, and con-
Perioperative Services sciously decreasing conversations with assistance of the visual
Vanderbilt University Hospital aide were successful. These interventions are easily translatable
glendyle.levinskas@vumc.org
to other similar environments.

Savannah Ramsey, RN2, BSN
Holding Room/Post Anesthesia Care Unit
Vanderbilt Children’s Hospital
savannah.v.ramsey@vumc.org