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MD Anderson Inpatient Unit Gives Patients the Silent Treatment

Dimmed Lights, "Yacker Tracker," Hushed Tones Contribute to Quiet Hour on Floor

MD Anderson News Release 05/01/09

Shhhhh. Hush. Quiet. Shush.

At The University of Texas MD Anderson Cancer Center in Houston on a busy 32-bed inpatient unit that cares for patients with melanoma and sarcoma, a designated hour of silence is much appreciated by not only patients and their families, but the nurses and staff who work on the floor.

Yvette Ong, MS, BSN, RN, OCN, associate director of nursing on the unit, reported that while additional measures will need to be implemented to positively influence patient outcomes, noise levels on the floor have dropped dramatically during the designated time. Ong presented her project at the 34th Annual Oncology Nursing Society Congress this week.

Ong first saw the Quiet Time in action on another MD Anderson inpatient unit and decided to implement the initiative in 2007 on the floor she manages. Her goal was to provide patients with uninterrupted personal time amidst the disruptions of a typical day on an inpatient floor and ultimately, improve patient satisfaction.

So Ong and her unit designated noon to 1 p.m. every day as Quiet Time.

"In addition to the care that we give our patients, we also have to provide a restful setting," said Ong. "Quiet Time has helped the floor appreciate that the noise is ever present and it has raised their overall consciousness."

As part of the project, Ong reviewed literature and found that noise on an inpatient floor causes patients not only to lose sleep, but it stirs anxiety, stress and cardiovascular stimulation, reduces pain tolerance, decreases wound healing, delays recovery and causes early readmissions.

Ong said it was clear where the noise was coming from: staff and caregiver conversations, industrial floor cleaners, medical equipment alarms, ice machines, paper towel dispensers, footsteps, telephones and pagers, ventilation systems and pneumatic tube systems. Patients were exposed to noise 24 hours a day, she said.

During the Quiet Time, she said, the level of noise, light and activity are kept to a minimum. In addition, patients' room doors are closed, overhead paging is reduced, lights are dimmed, ringer volumes on the telephones are lowered, the multidisciplinary team working the floor speaks in hushed tones, nurses respond to alarms quickly and prolonged conversations are held in areas beyond the nursing station. Nurses ensure that patients' immediate needs, such as pain or nausea medications, are met prior to Quiet Time.

While the nurses and ancillary staff police each other, the two bold traffic stoplights known as "Yacker Trackers" bolted to the wall near the nurses' station are a startling reminder to tone down the tones. The devices are preset to decibel levels and when they pick up an overly enthusiastic conversation or clacking hard-soled shoes, then the "Yacker Trackers" alert staff with a flashing red light.

As part of the project, Ong measured the decibels before and after Quiet Time at the specific locations around the unit.

In the medication area, during normal operations, the noise levels ranged between 62 - 73 decibels while during Quiet Time it was 53 - 57 decibels. In patient rooms during normal times, the range was 54 - 69 decibels and during Quiet time it was 42-44 decibels. In the perimeter between patient rooms and the nursing station, the noise level was 54-66 decibels during non-Quiet Times and 48-52 decibels during the designated silent time.

Ong said the World Health Organization recommends that noise levels in hospitals not exceed 45 decibels during the day and 35 decibels at night.

"The nursing staff on the unit takes Quiet Time seriously. They orient our incoming patients and their families about the designated time so we never lose sight of what we're trying to accomplish," said Ong. "The patients help us spread the word, too. They are serious about getting their Quiet Time just as we are."

MD Anderson Cancer Center in Houston is home to approximately 2,700 professional nurses and one of the largest concentrations of RNs in the nation. MD Anderson nurses provide care at the bedside as well as in clinics and services such as translational research, radiation oncology, infusion therapy, education and diagnostic imaging. MD Anderson is located on the campus of the Texas Medical Center and is one of the world's most respected centers devoted exclusively to cancer patient care, research, education and prevention. 05/01/09


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