3 Strategies to Stop Noise Distractions as a Team

Reducing noise distractions is one aspect of patient safety that OR teams at Vanderbilt University Medical Center in Nashville, Tenn., take very seriously.

Through a multi-year initiative to measure and address noise distractions, perioperative nurses, surgeons, and anesthesia providers have found surprising sources and detrimental effects of OR noise, notes Cynthia Kildgore, MSHA, BSN, RN, CNOR, director of Perioperative Services at Vanderbilt University Medical Center.

“We were amazed to see how loud commonly used surgical equipment such as the bovie measured. We were also surprised to see how distracting white noises such as alarms can be and how often a team member will mute an alarm to reduce the noise,” Kildgore shares. Poorly timed team conversation and sounds of equipment clanking together in movement also rated loudly.

Studying these measured noises using the NIOSH noise level measuring standards showed that peak noise levels were 106 DB(A), as loud as an ambulance siren—high enough to damage hearing and certainly loud enough to risk important team communications that could negatively impact patient safety.

Team member perception of OR noise was also compared and showed that during anesthesia emergence, team perception of noise was 40% less than the actual measured noise.

A Team Approach to Tackling Noise Distractions

Through collaborative and multidisciplinary work among OR team members, strategies were identified and implemented to mitigate noise distractions.

Here are three strategies that are helping to keep the ORs Kildgore oversees quieter and less distracting.

1. Create a Safety Culture Where Noise Distractions are Called Out

Noise distraction is not a new concern in the OR, but it is a persistent problem that must be addressed as part of broader work to strengthen a safety culture, Kildgore stresses.

“In our ORs, any member of the team is encouraged to call out a noise distraction immediately and the team member or group of team members responsible for the noise are equally responsible for thanking the person who called out the noise. Such interactions are only safe when practiced in a culture that respects and expects safety in all aspects of care.”

2. Perfect Situational Awareness

Situational awareness in the OR is the ability to to assess your climate in your room, including noise distraction as well as any other situations that will distract from giving good patient care, Kildgore describes. “This is a learned skill that some people have a natural talent for, and others need to consciously practice.”

She describes several important times during the surgery are critical for situational awareness, including during induction, during critical moments in the surgery and when the patient comes out of anesthesia. For example, during induction, team members should be conscious about their voice level, say when they are completing the count and when moving surgical tools and equipment.

3. Empower RN Circulators to Guard Against Noise

Kildgore stresses that RN circulators should have enough control of their room to address any and all noise distractions immediately.

“The circulator is the oversight committee for his or her room and they need to be given the power by their colleagues in the room and their leaders to call out noise concerns, she says. Challenges such as establishing yourself as a new nurse and overseeing a busy OR full of people, especially in a teaching hospital, can make this room control challenging for RN circulators.

Pushback from team members who do not acknowledge their part in noise distraction is a common occurrence preventing noise reduction strategies from working—this is why a team approach within an established safety culture is critical, Kildgore cautions.

“Everyone in the room needs to have the ability to speak up when they see something isn’t right with absolutely no retribution. This is the only way to create a safe culture and addressing distractions is a huge part of this safety practice.”

Free Resources for Members

• Guideline Essentials: Minimize noise and distractions in your OR with ready-to-use templates, tools, and implementation steps for Environment of Care.
• Webinar: Guideline Update: Safe Environment of Care Replay (1 CH)
• AORN Journal CNE Articles:
  • Guideline Implementation: Team Communication (1.8 CHs)
  • Clinical Issues June 2018 (1.5 CHs)
  • Clinical Issues January 2019 (1.1 CHs)