Analysis

Our survey reveals noise still a problem on wards

A new survey shows that too much noise is still a major issue on hospital wards – but some nurses are tackling the problem
Nurse Nicky Beecher

A new survey shows that too much noise is still a major issue on hospital wards but some nurses are tackling the problem

It is an issue that has plagued hospital wards for decades.

And a national inpatient survey, published in June, reveals a significant number of hospital inpatients continued to be bothered by night noise.

Out of 70,581 patients surveyed in 2015 by the Care Quality Commission, 38% were bothered by noise from other patients and 20% by noise from hospital staff.

In response, Nursing Standard surveyed all NHS trusts and health boards in the UK to learn more about what measures are being taken to tackle noise.

Types of noise

Television noise, beds being moved, healthcare staff talking, working machinery, bins and doors closing are

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A new survey shows that too much noise is still a major issue on hospital wards – but some nurses are tackling the problem

Nicky Beecher understanding noise
Patient experience manager and nurse Nicky Beecher discusses noise issues. Picture: Tim George

It is an issue that has plagued hospital wards for decades. 

And a national inpatient survey, published in June, reveals a significant number of hospital inpatients continued to be bothered by night noise.

Out of 70,581 patients surveyed in 2015 by the Care Quality Commission, 38% were bothered by noise from other patients and 20% by noise from hospital staff.

In response, Nursing Standard surveyed all NHS trusts and health boards in the UK to learn more about what measures are being taken to tackle noise.

Types of noise

Television noise, beds being moved, healthcare staff talking, working machinery, bins and doors closing are some of the common patient complaints recorded.

At Warrington and Halton Hospitals NHS Foundation Trust, six patient complaints related to noise generated by staff, including one about a nurse discussing confidential information too loudly.

Similarly, an older patient at the Royal Free London NHS Foundation Trust complained of being unable to sleep for six nights ‘because of noise from patients and staff.’

Raising awareness

Patients Association chief executive Katherine Murphy says patients do accept that hospitals can often be busy places, but warns unnecessary noise takes its toll on those recovering from illness.

‘If you don’t sleep it has an impact on how you feel the next day,’ says Ms Murphy.

‘Low energy levels and lethargy can contribute to other things taking longer in hospital, or even to patients being discharged earlier than they should be.

‘Sometimes nurses can be doing things on automatic, such as pulling a curtain, rather than doing it gently – staff can be aware of what they can do to cut down on noise as much as possible.’

Ms Murphy adds that patients can be noisy too.

‘Lots of patients can’t help being noisy, for example someone with dementia may be confused and disoriented, if out of their normal environment.’

Not a new problem

In 1956, the King’s Fund funded a survey of more than 2,000 patients about noise in hospitals: these inquiries were repeated in 1960 and 1973.

The early surveys mention cats, jackdaws, tugs on the river, and even a rifle range as sources of disturbance, while road traffic was the biggest complaint in 1960.

Later complaints reflected the popular growth in television and radio use.

Today, many NHS organisations are displaying commitment to tackling this issue.

New measures

Last year, the National Institute for Health Research awarded Oxford's Kadoorie Centre for Critical Care Research and Education a £280,000 grant to investigate links between noise and recovery in intensive care.

Kadoorie Centre for Critical Care Research and Education's Duncan Young says his team’s research found noise levels in the ICU were equivalent to a busy restaurant and designed a programme of noise-reducing changes.

‘ICUs are noisy places and people have completely disordered sleep, even when they are not drugged,’ Professor Young says.

‘This may be one cause of delirium and hallucination and that is the link through to harm: the possibility that this disturbed sleep increases psychological upset.’

The research has been used by Oxford University Hospitals NHS Foundation Trust (OUH) to design a programme of noise-reducing changes, such as soft-closing bins and guidelines for volume levels on equipment.

Staff have also undergone sensory simulation to experience ICU from a patient perspective. Wearing glasses that simulate poor vision common in ICU patients, staff hear a soundtrack of common sounds in the unit while colleagues move around the bed to mimic normal nursing activities.

Trust-wide priority

OUH chief nurse Catherine Stoddart is concentrating on reducing noise at night as a trust-wide priority.

Recent OUH inpatient survey results were worse than the national average on ‘noise at night from staff’, but Ms Stoddart is keen to learn from the Kadoorie findings, as well as best practice in other trusts.

‘Noise is such a fundamental issue for patients, so an important part of the project will be about setting standards,’ she says.

Research trialling the effectiveness of eye masks and earplugs is taking place across a mix of general, medical and surgical wards.

Sleep improvement

Imperial College Healthcare NHS Trust ran a sleep improvement project over a year-long period which saw a 22% reduction in the number of patients rating their sleep as only fair or poor.

Staff on 18 clinical areas were asked to close doors to minimise noise and light, and answer the nurses’ call system immediately, among other measures.

Imperial lead site nurse practitioner Andy Brittin who co-authored the study, published last March, says certain nurses were nominated as ‘sleep champions’ on wards to help bring about changes.

‘I see a lot of practice which troubles me about light and noise,’ says Mr Brittin.

‘Just because you are on nights, it doesn't mean the patients are.’

Tackling noise at University Hospitals Birmingham NHS Foundation Trust

University Hospitals Birmingham NHS Foundation Trust has 1,213 inpatient beds and 3,500 nurses.

Patient experience manager, nurse Nicky Beecher, has been leading a noise at night project since surveys revealed poor sleep was an issue.

‘It’s a national problem, everyone struggles with it, but we really wanted to do something about it,' she says.

In 2010, the trust scored 7.3 out of 10 in national patient survey results for noise – the best trust at the time scored 9.2.

In response, the trust carried out two major audits of patients and staff in 2011 and 2014 to find out what they thought got in the way of sleep.

The research revealed: pain; staff attending to patients; patients needing to use the toilet; and noise from other patients were the main culprits, rather than staff talking.

New measures included:

  • Pen torches properly stocked on wards.

  • Staff guidelines on helping patients sleep.

  • Soft-close bins.

  • Sleep kits with eye mask and earplugs.

  • Patient leaflets with sleep tips.

The trust’s national score rose to 7.9 in 2011, and, after changes were embedded, to 8.1 in 2012 (also its current score).

The second audit showed everything had improved except for noise from other patients.

‘We haven’t cracked noise at night, but we are not going to let this go until patients in our hospital get a good night’s sleep,’ Ms Beecher adds.

‘There are things that are notoriously difficult to get right and remain a national challenge – noise is one of them.’

 


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