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Expected sound levels of common occurrences are found through the NIOSH SLM application (Table 1).11 Sound is measured in decibels and the term “L” represents sound level, while “LA” represents A-weighting sound level, which applies a weighted
the sensation of sound pressure. A sound level measured in with better correlation to high noise level responses in humans.12
A sound level “peak” is the maximum level of a raw noise. Therefore the “LCpeak” refers to a maximum level of sound that correlates best to a human response to sound while the “Lmax” or max level is the root mean squared maximum level of varying noise and best used if noise levels are constantly changing within Table 2).13
OBSERVATIONS
ranged from 77.2 dB– 110.3 dB. Sources of noise occurred from machines and alerts intended for patient safety, comfort, and include conversations or confused screaming from patients themselves, except for one recording with a peak level of 103.5 dB coming from acute care staff conversations (Table 2).
An observation that occurred four times out of the recorded 21 sounds originated from the same scenario. The same patient, with base line confusion and disorientation, was found to be agitated around the same time of day, causing the patient to start screaming in the hallway in a shrill tone, often incomprehensible speech, other times with the word “help” mixed within sentences, while other patients, up to six seen at one time, also came into
the hallway from their rooms to observe or pacify the screaming patient. A staff member was observed trying to separate the patient from a ringing phone which seemed to have initiated
the screaming on one occasion. Due to the daily occurrence of this event, the observed staff present at the time of screaming were often continuing their current task, unable to redirect the screaming patient. The patient was on a medication regimen that if adhered to as scheduled would decrease the daily agitation.
Another observation was noted when interviewing a new patient at a long-term care facility, another patient began screaming at peak three minutes. During that time, the patient being interviewed was unable to answer questions appropriately and the patient’s speech
became incomprehensible. After the start of the screaming, the new patient became more agitated and confused. There was not a prompt response from caregivers, possibly attributable to desensitization to noise, to separate, distract, or soothe the screaming patient in efforts to decrease the sound level and others’ agitation.
To assess patients’ response to noise, multiple patients at a long-
term care and skilled nursing facility were asked about the sounds. One of the patients was hesitant to answer and did not want the response to be perceived as a complaint that may have a negative impact on patient care. Another patient reported that due to hearing impairment, the noise did not make as much of an impact on personal well-being. A third patient reported being “fed up” with the noise levels, adding it to a long list of problems and concerns with the facility. These patients were chosen based on their ability to answer questions. Therefore, patients that were critically ill or demented were not interviewed, although those patients were often observed becoming disoriented and confused by excessive noise.
DISCUSSION
Although some patients and care givers are accustomed to
the sound levels, the variety of loud sounds were found to be distracting for health care providers and patients, making it Limited efforts were observed to decrease the magnitude and latency of sounds, possibly contributing to alarm fatigue and desensitization by those care givers constantly immersed in the environment. In long-term care, skilled-nursing, and acute-care facilities, care giver alarm fatigue needs to be addressed.
Often, the constant alarms can induce disoriented patients such
as new, critically ill, or patients with dementia into further confusion and fear, resulting in agitation among other patients. In patient medication schedules, an administrative decision should be made to allow at least one care giver to be on a schedule that allows proper dispersion of medication to prevent increased confusion
and subsequent noise levels in a facility. Although a completely quiet, peaceful health care facility may be close to impossible, being aware that the noise levels are inappropriate and encouraging family and patients to comment on discharge evaluations from facilities regarding noise levels is an important step towards decreasing excessive and unnecessary noise in the future.
in some facilities around the world. Basic information regarding design recommendations and using an acoustic consultant are currently available.14 The ABCs of acoustics — absorb, block,
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Del Med J | March 2018 | Vol. 90 | No. 3
