Wednesday, May 24, 2006

Hospital noise

At least one hospital appears to have gotten the message about noise:

The sound echoed throughout Montefiore Medical Center, like somebody pounding dozens of nails around the clock.

Wham! Wham! Wham!

The source was actually a pill banger, used to crush medications for geriatric patients who can't swallow whole pills.

The process occurred repeatedly each shift, disrupting sleeping patients and annoying employees. It was finally replaced by a pill grinder, more pepper mill than hammer, part of a noise-reduction campaign that includes rubber wheels on instrument carts, soft-soled shoes and posters reminding staff members, patients and visitors to pipe down.


Anonymous Moof said...

I wish all hospitals would get the "message" about noise. Whenever I'm hosptitalized, I give up on the idea of getting any sleep until I'm discharged.

You'd think it wouldn't have to be that way ... considering the hospitals are full of sick people who need to be able to rest ...


9:56 AM  
Anonymous tired mom said...

Here's another idea, turn off the overhead page. In a well-known children's hospital (in which I have spent a fair anmount of time) the page is on until 10 pm and then back on at 7 am. Now, my son goes to sleep at 8 pm (like a good 6 year old), the page wakes him up - seizure.
Can I cover the speaker so he is not awakened again - no, against hospital policy.
and let's not even mention the 5 am blood tests and the resident's examinations at 6 am.
so why is my child not recovering?

10:55 PM  
Blogger Amy Tuteur, MD said...

I agree.

One of my children was hospitalized at a "well known children's hospital" and I was appalled at the level of noise, particularly unnecessary noise. The nurses all carried cell phones, yet they would page each other overhead all night long. I complained, but no one seemed to even understand what I was talking about.

8:01 AM  
Blogger Flea said...

Slightly idiosyncratic view here:

Yes yes yes, a thousand times yes noise should be reduced.


When the need to reduce noise and the disturbance to sleep/rest becomes more significant than the need for hospital level of care, the patient should go home, where it will be quieter for sure.



7:28 AM  
Blogger NeoNurseChic said...

One night I wandered out of my cardiac step-down unit room to find a new set of leads yet again. My monitor was going off and it wasn't from all the PVC's and tachycardia I was having - it was because the room was hotter than hell (and I'm always cold) and the leads kept on falling off, which made the monitor beep incessantly. The charge nurse was my nurse for the night, and she looked up as I opened the cabinet outside the door to get out more leads. I remarked that the noise from monitors and everything else had kept me up all night the night before and this night I hadn't yet slept. You'd think a person would eventually just be so tired that they would sleep nonstop, but I had been in the hospital for well over a week at that point, and I was tired of sleeping all the time. I felt restless and it didn't take much to keep me awake all night!

The next time I was on telemetry, it was a different unit in the same hospital and they were able to make the monitor only alarm in the hallway. So quiet in fact that I didn't hear it alarm and was a little surprised when 2 nurses and a tech came running to my room during repeated bouts of SVT. This had become such a "normal" phenomenon for me that at first I wasn't paying attention to my own body, and I definitely didn't hear the monitor alarming for a heart rate over 200!

On one unit I used to work on in the same hospital, they had a stoplight. At first, I didn't get what it meant. But the Red light flashed when the light sensed the noise got too loud! Brilliant!

On our unit in neonatal, I'm constantly shutting the lights off. Nothing grates me more than when I see a nurse, visitor, physician or other staff slam the door of the isolette. That's like tapping a fish bowl... :( They have latches on them for pete's sake! All isolettes are capable of being closed without a slam! I feel so badly whenever I accidentally bang something against it loudly... I truly hate when developmental measures are not respected...!

Take care,
Carrie :)

1:51 AM  
Anonymous Celeste said...

I'll tell you what's loud...VELCRO. It's on the blood pressure cuffs and those foot cuffs for clot prevention. Every time somebody adjusts or removes/replaces it, yikes. And then there are the auto devices on the cuffs--every time they puff up and do their thing, the velcro gives off noise. It's really hard to rest with that noise going on intermittently.

There are a lot of things that screech, too. I suppose a lot has to do with a person's general anxiety level making it seem worse. I just wonder why noise isn't taken into account...especially when there isn't any normal sound-deadening material on the floors and walls of most hospital rooms due to sanitary considerations.

3:56 PM  
Anonymous Anonymous said...

Have you thought about taping the noise and taking the tape to the hospital board? Writing a letter to a professional journal to try to educate some of your peers?

There are studies about noise pollution and its effects.

8:26 PM  
Blogger Danielle said...

I just stubled upon your blog and I have to tell you that the post below this one (about Ida) had me on the edge of my seat. Wow! Thank you for your honesty

5:55 PM  
Blogger Amy Tuteur, MD said...

Thanks for your kind words, Danielle. It certainly wasn't my finest moment.

9:42 PM  
Blogger badyoga said...

Those beeping IV machines...when I was in a hospital my 'roomate's beeping IV machine went off every few minutes becasu she would fall assleep on the tubing. then I would call the RN to come dodwn and turn it off ...I got less that 5 hrs sleep in 48 hrs post surgery, thought i would die. If I COULD have gotten up (had those balloon things on my legs that would inflate periodically). Had I been physically capable, I would have gotten up and unplugged that damn IV machine from ms. driskoll.

8:23 PM  
Blogger Ex Utero said...

Hi Amy,

You are the recipient of a dedication in the Plague Town Anthology Today.



2:33 PM  
Blogger ED Doc said...

This comment has been removed by a blog administrator.

11:21 PM  
Blogger ED Doc said...

Great example of the law of unintended consequences. Let's make a machine that will inform of us if something is not proceeding correctly so that the patient can recieve the correct treatment and improve. However, the reality of almost all alarms is that they go off inappropriately or for non urgent reasons. Most are frequently ignored anyway by the medical staff and when you put 30 of them in the same room they all lead to excessive noise pollution an unpleasant experience for nearly every patient.

11:25 PM  
Blogger ozdocblog said...

The most annoying part of hospital life is lack of sleep, so glad to hear of these measures, not sure if Aussie hospitals following suit. It's not just the noise, but the insistence on leaving lights on all night in corridors that shine into your face.
Not to mention the nurses, who have to come and 'handover' at the start of each shift. Dont know why I had to be woken every time to tell the details that were on the bedchart.

2:37 AM  
Anonymous Anonymous said...

This comment has been removed by a blog administrator.

11:12 AM  
Anonymous Anonymous said...

Flea, with all due respect, that's bullshit.

Ahem. Our L & D unit is staffed with some of the laziest nurses ever. They appear to be tethered to the chairs in the nurses station.

I delivered my last child there, and it's not a lot of fun to be awakened from a post-labor nap by a nurse using the call system in every patient room, "Sharon??? What room are you in??" in order to let her know she has a phone call at the desk.

Some noise is definitely unnecessary, regardless of how close one is to discharge. It's a small unit; get off your fat ass and find Sharon yourself.

2:26 PM  
Blogger SuperStenoGirl said...

As I type this directly over my head is an air intake thingamajig. Basically a circular ventilation duct covered with a grate. On the second floor they are doing major construction to the ICU and since 8 am (its now noon) I have heard nothing but BANG BANG BBANG.....BANG BANG..SMASH BANG BANG...SMASH SMASH.. It makes me want to twitch - actually I am.

I get construction has to happen but.. couldn't they pound a little less loudly?

As for other hospital noise - totally in agreement. The wards are quite noisy and it's just.. not conducive to people recuperating and trying to get better. :(

2:54 PM  
Anonymous Tom, MSN, RN said...

I hear you all about the LOUDNESS of modern inpatient units, and I'm a nurse! It is unreal how loud nurses, aides, physicians, and phlebotomists can be, especially at 7 am! Back in the old days, it was recommended that nurses speak in hushed tones, just loud enough to be heard in a 2-3 foot radius. Nowadays, nurses yell from across the unit that someone has a phone call or... perhaps the most unprofessional thing I have every heard... "Mrs. S needs to get on the commode, like, now! She's shitting the bed and we are out of diapers! (this one came from an aide who I VERY promptly pulled aside to have a conference...)". One thing that has been lost in the drive for technologically savvy nurses is human dignity, respect, and the "hospital milieu" of healing and peace. IV pump occlusions and empty IV bags can be prevented through nursing assessments and interventions such as teaching the patient not to bend their arm, using arm boards, or heaven forbid putting the IV in a place other than the antecubital fossa for a change! Nurses can estimate the amount of time an IV bag will need to be changed by doing some simple math, and that's one (or two) fewer sets of beeps that can be avoided. The speed with which these beeps are addressed has actually been addressed by JCAHO, requiring that all "critical alarms" (including IV pumps) be checked on immediately. A unit culture of quietness, peace, and tranquility can go a long way in eliminating unnecessary anxiety in hospitalized patients, particularly those at high risk for delirium.

7:08 PM  
Anonymous Anonymous said...

AMEN! Both times I've been hospitalized I was stunned at how loud it was in the middle of the night- 1, 2am- vacuuming, fixing things.

8:44 AM  
Blogger terri w/2 said...

When one of my twins came home from the NICU, she absolutely would not go to sleep. Finally, we put her bassinette near the closet, turned on the light and put a radio under her bassinette for "noise" - she went right to sleep.

I believe that if NICU's were quieter and calmer, much of what we are seeing in adverse outcomes could be somewhat lessened. They use sleep deprivation for torture, for Pete's sake! Imagine a fetal infant who is being awakened at all hours of the day and night for procedures, often painful, and then also for their NICU neighbor's procedures when they are suppose to be sleeping 18 hours per day! It's gotta be doing something bad to their neuronal development. And, considering that the brain develops most rapidly during the last 3 months of pregnancy, and they are spending those last 3 months in the outside world - is it any wonder so many of our kiddos without brain hemorrhages are also so damaged?

6:32 AM  
Blogger Tif said...

I love this blog! I wish there was a hospital I could go to filled with doctors like you. I just got done with a related posting on my blog, only it's written more from the patient perspective. I hope you can check it out!!

5:08 PM  
Anonymous Anonymous said...

Anon, the reason the nurses in L & D are tethered to their chairs in the nurses station is due to the assinine amount of paperwork they must fill out due to high risk for litigation. I'm fairly certain they would love to have some of that paperwork taken away. Complain to management.

I tend to agree with Flea. Yes, there needs to be a reduction in noise but some things just can't be helped. Just last night I had to listen to patients gripe because of the noise - guess what the noise was caused by? The alarm going off was the CODE BLUE button. Someone was dying, sorry to inconvience the rest of you but we were trying to save a patient.

This is a hospital, and unfortunately you probably are going to be awakened in the night. The first 24 hours we do 4 hour vitals. We do labs very early in AM (starting at 4AM) so the results will be available when the docs do their rounds. For those patients who cannot bathe themselves 1/2 get their baths during the day, and 1/2 get their baths at night (we simply do not have enough PCA's to have this done at every patient's convenience). There are a lot of annoyances that patients have to put up with in the hospital, but it is not a hotel. So, the "do not disturb sign" you placed on your door will likely be respected (we will just document that you refused vital signs) and then if you stop breathing during the night, well I guess we won't know it.

6:29 PM  
Blogger MysteriousLady said...

I am researching the effects of noise on patients.

I worked nights these last 2 months, and was shocked at how loud the nurses and support staff were. Asking them to "Be quiet please" brought an array of , well, expressions I won't repeat.

Now I'm on a mission. To make the hospital more aware of the effects.

Our hospital Lab techs, and transporters all use walkie talkies. Which they keep at the highest level. When I asked them to please turn them down. They flat out refused.

I'm just truly amazed. 10 years ago I worked night shift, it was so quiet you could hear a pin drop. Now, I worked it to train 2 new grads, my god! It's like grand central station. All the patients were complaining. Not to mention. When lab came up at 2:30am to do am labs, their walkies would wake the whole population. Every call light went on! All asking for pain meds, or coffee since now they were awake!

There's gotta be a better way.

7:38 AM  
Anonymous Mark said...

It’s good information for sharing. I like it very much. Great... keeps it up good work!!!!

3:51 AM  

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