Semester

Fall

Date of Graduation

2024

Document Type

Problem/Project Report

Degree Type

DNP

College

School of Nursing

Committee Chair

Susan McKenrick

Committee Member

Aaron Ostrowski

Committee Member

Keshang Wang

Committee Member

Michael Russell

Committee Member

Jeanne Grimes

Abstract

Problem: Excessive intraoperative noise puts anesthesia providers at risk for errors that could negatively impact patient morbidity and mortality. Distractions from excessive noise experienced during the “critical phases” of anesthesia present a risk to patient safety and need to be reduced or eliminated. Anecdotally, reports from anesthesia staff at a large academic medical center confirmed that noise pollution during induction and emergence significantly impacted the performance of critical anesthesia tasks. Objective: The goal of this quality improvement (QI) project was to implement a series of interventions designed to reduce noise pollution during induction and emergence, and to reduce distraction experienced by anesthesia providers. Methods: The interventions consisted of turning off music during induction and emergence, using signs within the operating room (OR) to indicate to staff the critical periods of induction and emergence, reducing unnecessary entry and exit from the operating room, eliminating all case-irrelevant conversation during induction and emergence, turning off ringtones, and the provision of educational in-services to faculty and staff, both in-person and via digital media formats. This project was carried out over the course of five months. Sound pressure meters were used to measure decibel levels during induction and emergence. Additionally, the National Aeronautics and Space Administration (NASA) Task Load Index (TLX) was used to measure the subjective mental workload experienced by the certified registered nurse anesthetist (CRNA) during the case (n=20). Results: While no demonstrable change in decibel levels were appreciated, survey respondents demonstrated a reduction in mental strain (p=0.007), physical demand (p=0.460), temporal demand (p=0.447), perceived effort (p=0.28) and frustration (p=0.796) during the induction and emergence phases over the course of the project (p=0.274). Conclusion: NASA-TLX analysis as well as anecdotal reports from the facility demonstrated that the project was successful in reducing the impact of noise pollution on the CRNA

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