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standardized quiet time (qt)

Jessica Castaneda, BSN, RN

Jennifer Petersen, BSN, RN

TH15 W MICU

Key Words

III. Evidence Appraisal

Objectives

Outline of Presentation

Search strategies/databases used

  • Medline Database (PubMed/Ovid)
  • CINAHL
  • Joanna Briggs Database

Inclusion/Exclusion criteria

  • Critical care settings
  • English language articles

Noise Reduction

Quiet time

Quiet hours

Alarm fatigue

ICU Delirium

Patient satisfaction

Healthcare environment

Light Reduction

Sleep deprivation

Sleep quality

Describe quiet time (QT)

Describe ways to effectively engage staff and patients in QT initiative

Explain benefits of QT on patient outcomes and satisfaction.

Identify evidence based interventions effective in reducing patient disruptions

I. Overview of Problem

II. PICO Question

III. Evidence Appraisal

IV. Action Plan

V. Conclusion

ii. pico question

Does a standardized quiet time (QT) improve patient satisfaction for critically ill patients?

Definitions

I. Overview of Problem

Appraisal of Evidence

Synthesize Evidence/Summarize Major Findings continued

Synthesize Evidence/Summarize Major Findings

Other floors/units in our hospitals have quiet hours

with visible signage.

P- Critically ill patients

I- Strict/standardized quiet time

C- Without set quiet time

O-Patient satisfaction

Quiet Time (QT): "defined period where there is a reduction in controllable light and sound, and where interruptions at the patient's bedside are minimized". (Kim, 2018)

Alarm Systems Management: Reducing alarms by safely making adjustments to the monitoring device based on the patient’s medical condition (Nurse Residency Seminar, 12 July 2018)

During our transition to night shift, we were made aware that the MICU implemented standardized strict and quiet hours during night shift in prior years. However, this unit culture has been less enforced in prior years.

HCHAPS quiet time at night metrics are in the lowest percentiles at NYU (Alarm Systems Management Nurse Residency Lecture)

Excessive noise in ICU settings due to:

  • Continuous telemetry
  • Constant care provision
  • Mechanical ventilation

Decreased patient satisfaction from sleep deprivation/sleep interruption

Strengths

  • In general, findings are constant and similar
  • Interdisciplinary efforts
  • Physiological and psychosocial patient benefits found

Weaknesses

  • Low level research
  • Some inconsistent findings
  • Lacks specific interventions
  • QT protocol variations
  • Various ICU settings/levels of monitoring
  • Inconsistencies in evaluation of sleep quality

iv. i.Improved patient outcomes

1.less delirium

2.less sedation needed

3.reports of reduced stress and anxiety

4.Physical benefits

  • Immune
  • Cardiac,
  • Pulmonary
  • Glucose control
  • Tissue Healing
  • Day time activities/wakefulness

i.Increased patient satisfaction

ii.Better workflow

“Nursing staff reported quiet time gave them time to catch up on charting, reducing their stress and allowing better care to be given when it was over” -- not only will strictly enforced quiet hours increase patient satisfaction, it will also improve RN satisfaction and better patient care

iii.RNs reported difficulty implementing QT protocols

Ongoing clinical ladder projects on our unit for ICU delirium. Quiet time can improve ICU delirium as well.

IV. Action Plan/Recommendations for Practice

Action Plan/Recommendations for Practice

Plan for Evaluation

Adapting to Local Context

V. Conclusion

References

Any questions, comments, or feedback?

Thank you so much!

1.Day and night shift:

a.Cluster care

b.Place foam paddings on laundry bins

c.Position changes prior to and immediately after quiet hours

d.PRN/pain meds strategically administered around quiet hours time

e.No visitor limitations - just increased awareness

f.Culture shift to establish QT as priority

Thank you so much!

Set time 1-3AM, 1-3PM (previously quiet hours 2-4AM, AM labs are due at 4 AM, which could have limited RN “buy-in” in prior standard)

Quiet hours signs throughout the unit to establish the culture and visibility for staff, visitors, and patients

“Do not disturb” signs like L&D unit

Ongoing education and reinforcement of interventions by staff and patients are necessary to provide optimal quiet time

Simple, cost effective interventions can be effective in achieving QT goals

Increased quiet time can improve patient outcomes and satisfaction

“The combined efforts of nursing, medicine, and ancillary staff are necessary to foster periods of uninterrupted rest, thereby optimizing patient care” (Maidl, Leske, & Garcia, 2013).

1.Collaborate with current delirium RN project on unit

2.Assess hospital wide patient satisfaction scores

3.Staff engagement

4.Patient/family reports

5.“Yacker tracker”

6. ICU Diaries (Blair, Eccleson, Binder, McCarthy, 2017)

i.Alarm Fatigue/Alarm Systems Management lecture

1.Include alarm parameters in ICU checklist

2.Appropriate alarms for patient specific needs

3.Interdisciplinary efforts

ii.Limitations for ICU

1.Frequent time sensitive patient care activities and observation in ICU patient settings

2.Drip titrations

3.Frequent vital signs

4.Frequent medications

5.Difficult evaluation (patients sedated/intubated)

2.During night shift:

a.Turn off lights

b.Lower shades

c.Limit awakenings

d.Turn computer screens away from patient bed

e.Close doors and curtains if possible

c.Offer eye masks/ear plugs if available/appropriate

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