Purpose: Research has shown that hospital staff are responsible for most of the noise and interruptions occurring at night. A decrease in sleep has been linked to increased length of stay, the risk for falls, and delirium while in the inpatient setting. Sleep disruption often begins around midnight with laboratory testing and continues throughout the night due to frequent vital signs and radiology procedures. To date, nighttime quality improvement projects found in research have been focused on the critical care environment. As a result, the quiet at night initiative was created to improve patient experience at night in the medical-surgical setting.
Description: The Quiet at Night pilot was initiated on two units from September 1 through October 31, 2020. Quiet at Night was defined in collaboration with the interprofessional team, which included laboratory, radiology, environmental services, public safety, and the medical executive committee. Through this team, quiet hours were established from midnight until 5 AM to allow patients to rest. During this time, staff dimmed the lights and care was clustered to allow for a period of uninterrupted sleep. Each patient was provided with a sleep menu that lists several available options for patients to help them have a restful night. The sleep menu included items such as a quiet kit (which contained an eye patch, earplugs, lip balm, word puzzle, and pencil), an extra blanket or pillow, a warm washcloth/oral care, a warm beverage, earphones, a care channel card, and aromatherapy. Unit decibel meters, also known as "yacker trackers" were also utilized at the nursing station during quiet hours to serve as a visual and auditory reminder to staff when they are too loud.
Evaluation/outcome: Through Quiet at Night, a decrease in noise levels resulted in fewer interruptions at night and improved patient restfulness. When patients were offered items from the sleep menu before bedtime, they reported an improvement in the number of hours of sleep. The project also increased staff awareness about the impact of noise on patients’ sleep. When staff became aware of patient feedback, staff seemed more motivated to act. The use of quiet hours likewise resulted in decreases in call light use, which decreased stress levels among nurses and promoted a healthier work environment.
Post-trial rounding Press Ganey patient survey results, in addition to HCAHPS results, were reviewed and analyzed for improvement in patients’ quality of sleep and perception of the quietness of the hospital environment. Of these results, 85-91% of patients reported experiencing a restful environment at night. In addition, an improvement was seen in 2nd and 3rd quarter HCAHPS scores, moving the hospital out of the bottom quartile percentage.
Quiet at Night has become one of the first initiatives to have successfully embraced interprofessional collaboration across this facility. After completing the trial, the night council presented an executive summary of recommendations to the hospital administration detailing lessons learned, challenges, and new changes to test and spread Quiet at Night to other hospital departments.