Noise and Distraction in the Operating Room.

Posted: December 14th, 2022

Noise and Distraction in the Operating Room.


Problem Description
In recent years, advancement in technology has afforded nursing and medicine several machines and tools that ensure patients undergo surgery with better outcomes. Unfortunately, these advances are associated with consistent noise that originates from their use. The operating room is an environment that requires a lot of concentration, situational awareness, and clear communication for the safety of patients since it is a setting where healthcare providers perform complex and high-risk procedures.Noise and Distraction in the Operating Room.


On the contrary, given the nature and amount of medical gadgets used as well as the number of healthcare providers present during operation, operating rooms are prone to noise. Dholakia et al. (2015) highlight different sources of noise and distraction as follows: music, irrelevant conversations, phone calls and pagers.
Noise as a potential distractor tends to divert the attention of healthcare providers from a task. This not only jeopardizes the safety of patients but also increases the risks of omission and mental lapse. In a recent study that evaluated the effects of noise post-surgery, there were high noise levels during wound closure of surgical patients that developed a surgical site infection suggesting lapse and distraction from complying with aseptic procedures (Keller et al., 2018). In the same study, disturbances such as irrelevant communication when conducting procedures in urology had a negative correlation with safety and standard operating procedures.Noise and Distraction in the Operating Room.
Setting/Context to Observe the Issue
The issue of noise as a health hazard can be observed in operating rooms. In the modern-day, pollution of operating rooms with noise at levels exceeding 55 decibels limits the effectiveness and efficiency of tasks that require a lot of concentration (Padmakumar et al., 2017). Noise can originate from extrinsic and intrinsic sources. Intrinsic sources include surgical tools, alarms, changing shifts and necessary communication. Extrinsic sources include beepers, cell phones, personal electric gadgets, calls outside the OR, visitors and unnecessary communication. Umadhay & Pedoto (2015) highlight how most hospitals have integrated new technologies into routine hospital information systems to access patient data. Although they might be useful when used appropriately, inappropriate use can cause distraction. It is inarguable that most surgeons today rely on digital devices to communicate beyond the operating room and office. This, however, can easily divert concentration from a procedure or a patient.Noise and Distraction in the Operating Room.
There are several sources of noise in ORs. Critical alarms are very crucial but can be distractors. False alarms are problematic thus identified as a potential area for harm reduction by the Joint Commission, which recommended the use of personalized smart alarms. There is also noise from surgical tools which can be considered during equipment selection and noise from OR visitors. There is also noise transmitted from corridors and other areas to the OR which can minimally be controlled since it is an architectural-based issue (Umadhay & Pedoto, 2015). Another noise originates from personal electronic gadgets used to play music, a habit that has prompted some healthcare organizations to establish policies that restrict the improper use of digital devices.
High-Level Detail Regarding the Problem
ORs are complex environments where safety and performance rely heavily on the smooth flow of information between healthcare providers. In the recent past, the levels of noise in operating rooms have been increasing steadily. In this entire period, many advances have been made in electronic gadgets used in theatres and those for personal use. There is a lot of progress in making surgical tools to reduce levels of noise in operating rooms but electronic gadgets are still the major contributors to the complex and unavoidable technology used in ORs. Operating room staff is subjected to power drills, cutting tools, saws, monitor alarms, contact between metals and dropped instruments (Weldon et al., 2015). The noise levels exceed 120 decibels due to confined operating rooms.
There has been a recent increase in the personal use of electronic gadgets and this distracts caregivers from concentrating on patients and providing safe care. More specifically, alarms and ring tones of individual electronic gadgets and electronic gadgets used in operating rooms are distractors. Similarly, the undisciplined use of cellular devices by members of the operation team can distract healthcare providers and impacts negatively on the health outcomes. Mentis et al., (2016) make reference to a study that was conducted at a large metropolitan hospital where the levels of sound pressure before, during and after surgical operations were monitored, it was noted that the sound pressure levels during orthopedic surgeries were highest (66decibels), followed by cardiology, neurosurgery, and urological procedures between 62-65 decibels Mentis et al., (2016). More than 40% of the time, neurosurgeries and orthopedic surgeries have sustained high sound levels exceeding 100 decibels (Mentis et al., 2016).Noise and Distraction in the Operating Room.
Noise is a form of distraction that interrupts the care of patients and increases the risk of medical errors. Noise hinders effective communication, increases the difficulty to comprehend the content and contributes to miscommunication. Noise and distractions should be managed to maintain safety and focus on patients in the OR. Yoong et al., (2015) emphasizes that the levels for persistent background noise in healthcare settings in the daytime should be 45 decibels according to suggestions provided by the EPA (Environmental Protection Agency). Healthcare providers should be educated on noise levels and miscommunication that occurs in operating rooms to safeguard patients and health practitioners from additional healthcare costs, noise-induced hearing loss, associated morbidities, and mortalities.
Impact of the Problem
Excess noise and distractions in healthcare settings have proven to impact negatively the safety of healthcare providers and patients. For instance, a prospective study that evaluated subsequent infection of surgical sites and the levels of noise in the OR revealed high levels of noise correlated positively with infections of surgical sites (Keller et al., 2018). It is difficult to communicate in environments with high levels of noise, which increases the occurrence of errors. Noise has been associated with poor concentration and performance of tasks. Noise reportedly caused irritability, dissatisfaction, fatigue, burnout, emotional exhaustion, stress and tachycardia among healthcare staff (Padmakumar et al., 2017). Distractions increased the probability of adverse health events in operation rooms by diverting concentration from a present task of a team member resulting in mental lapses and omission.
According to Mentis et al., (2016), noise and distractions are the major contributing factors of up to 50% of human errors that occur in hospitals. However, the impacts of noise and other distracting stimuli on the health outcomes of patients vary due to the infrequent occurrence of complications. Despite the scarcity of studies about the impact of noise and distractions, research suggests that noise impacts negatively on the performance of the technical skills of surgeons and affects surgical performance since lack of concentration can result to hemorrhage or visceral injury during or after surgery (Mentis et al., 2016).Noise and Distraction in the Operating Room.
Problem Significance and Implications for Nursing
High levels of noise in operating rooms have different sources starting from loud conversations to the handling of equipment. According to Yoong et al., (2015), neurologic and orthopedic operations usually reach noise levels that exceed 130 decibels. Modern-day monitors and equipment used in theatres reach levels as high as 85 decibels. This implies that, during peak noise levels, alarms of oxygen saturation may go undetected resulting in reduced oxygen status, which is a serious safety concern that can result in serious injury or even death.
High levels of noise are hazardous since they can lead to hearing loss and miscommunication between healthcare providers during surgery. Miscommunication creates discrepancies between surgeons leading to increased costs of care. It also results in a surgical miscount of sponges and instruments, which should be done before patient closure in every operation (Padmakumar et al., 2017). Research indicates that miscounts of sponges or instruments leads to additional healthcare costs and prolonged admissions since several follow up x-rays should be done to establish whether or not retained items are still inside a patient. Similarly, miscommunication inhibits direct patient care as it increases the difficulty to hear a request made by a patient intraoperatively (Padmakumar et al., 2017).
There are many complaints from anesthetists, OR nurses and surgeons about noise disturbance during surgery. Noise has several negative consequences on healthcare providers. Apart from leading to exhaustion, it elicits stress, impairs the performance of the sensorimotor system, communication and cognitive performance (Weldon et. al., 2015). It is linked to high levels of complications and errors in patients, impaired performance of the auditory system and irritates members of surgical teams. Among nurse anesthetists, exposure to noise impairs their mental efficiency, reduces the speed at which they respond to changes in patients and impairs the short-term memory. It is impossible to remove noise and distractions from the operating room. However, operating room staff ought to be committed towards the creation of a controlled environment with minimal noise, distractions, and interruptions.Noise and Distraction in the Operating Room.
Proposed Solution
The safety of surgical patients is a major theme in healthcare today as evidenced by a report from the IOM titled: To Err is Human: Building a Safer Health System. According to Hogan & Harvey (2015), after errors caused by surgical techniques, human errors are reportedly the most common. The following recommendations have been made to reduce the levels of noise in the OR; creating a no-interruption zone which prohibits non-essential conversations, establishing a code of conduct and implementing a policy to reduce noise, educating staff on noise and its impact to the safety of patients, fostering a safety culture and practicing effective communication strategies among healthcare team members.
Since research indicates that personal electronic gadgets produce the highest noise levels, the elimination of pagers and cell phones from OR suites is proposed as the most reliable and effective solution. Eliminating these electronic gadgets from the OR prevents undisciplined use, which can cause distraction and can compromise the care of patients (Mentis et al., 2016). Besides, cell phones and pagers can easily interfere with devices for monitoring patients among other technologies used to care for patients. Hogan & Harvey (2015) further suggest that electronic gadgets used to take and transmit photographs should be governed by hospital policy and regulations of the federal government on patient confidentiality and privacy.Noise and Distraction in the Operating Room.

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