Hospitals Establishing Quiet Measures to Promote Sleep for Patients With Cancer

Intercom announcements, bright lights, nurses bustling in and out of rooms — faced with these disturbances in a hospital, any patient would likely get a terrible night’s sleep.

But the foggy-headed, red-eyed exhaustion that comes from being awake half the night can be an especially big problem for patients with cancer, many of whom are already battling fatigue caused by their disease and its treatments.

An indication that cancer centers are aware of night-time noise and are making efforts to control it came during the Oncology Nursing Society’s Annual Congress in San Antonio, Texas in April. There, researchers presented four studies looking at overnight hospital noise and ways to reduce it.

“Noise, or unwanted sound, is one of the most frequent patient complaints on acute care oncology units,” wrote Mary Beth Leo, who holds a bachelor of science degree in nursing, and her colleagues at Memorial Sloan Kettering Cancer Center in their study. “Research has shown a link between noise disruptions and spikes in blood pressure, impaired immune function and pain management.” Excessive noise affects the “quality and effectiveness of healing” and hinders communication between patients and staff members, added researchers from Duke University.

Those two medical centers launched their noise-reduction efforts in reaction to surveys in which patients said they were not satisfied with night-time noise levels, and Froedtert Hospital, in Milwaukee, Wisconsin, started its program simply because night-time noise is understood to be a common complaint among hospitalized patients. Cancer Treatment Centers of America, in Philadelphia, also conducted a study, which mainly collected data about patient perceptions of hospital noise.

At Duke, a Noise Reduction Team used a decibel meter to measure sound levels associated with team stations, delivery carts, door closings and other activities. Team members then formulated an education plan that included placing Yacker Trackers — which change colors when noise levels rise — in the noisiest areas as reminders to staff; placing “Healing in Process” signs in hallways; distributing “Silent Hospitals Help Healing” buttons to staff; and teaching patients and their families about their role in keeping night-time noise to a minimum.

“Noise levels on our unit have been markedly reduced,” registered nurse Andrew Preston, the study’s author, wrote. “Patient satisfaction scores have improved from an initial 30 percent to current scores of 70 percent. Post-intervention staff surveys indicate a perception of a less noisy work environment, workflow improvement and an environment of safety and improved communication.”

At Sloan Kettering, October 2014 marked the beginning of an initiative on the hematology unit to raise staff awareness about noise and its effects on healing. Measures included disabling the overhead paging system and removing all telephones from hallways. During quiet hours between 11 p.m. and 6 a.m., staff members used more wireless voice communication, set their pagers to vibrate, avoided using cell phones in hallways, shut off computer monitors and dimmed lights. Interdisciplinary rounds began after 8 a.m. and bedside handoff occurred in designated areas outside patient rooms.

Before the start of the initiative, patients ranked their satisfaction with noise levels at levels below the hospital’s average in four of five consecutive annual quarters. Afterwards, scores rose above the hospital’s average in three consecutive quarters, an increase of 3 percent.

Froedtert Hospital, meanwhile, protected patients from noise by giving each of them earplugs, as well as a card that explained the causes of typical hospital sounds and promised a concerted effort to preserve quiet. The hospital placed noise reducers on the doors of patient rooms and asked staff members to respect a quiet time beginning each evening at 8 p.m.

In a survey, 14 of 17 patients said they had never or rarely been awakened by a sound during the night or day while staying in Froedtert’s oncology unit. In 2014, 60 percent of patients surveyed said that the area around their rooms had “always” been quiet at night; in 2015, with the noise-reduction measures in place, that score increased to 73.81 percent, said Froedtert study author Jamie Craig, who holds a bachelor of science degree in nursing.

“It is vital that nurses realize the importance of sleep and utilize their skills to decrease noise when possible,” Craig concluded.