Joint Commission Quick Safety Issue 35 - Minimizing Noise and Distractions in the OR and Procedural Units
The Joint Commission (TJC) Quick Safety Issue #35 addresses ways to minimize noise and distractions in the operating room/procedure units. According to TJC, ORs and procedure units are filled with noise and distractions that increase the risk of error and can potentially compromise patient safety.
TJC highlights several technical and behavioral factors contributing to the noise in ORs:
- Paging systems
- Wireless communication systems
- Music devices
- Medical equipment
- Monitors, clinical alarms
- Metal equipment, supplies
- Conversations (case-related and non-case related)
- Patient care activities
- Staff movement in the room
TJC notes that some studies have found the noisiest times in an OR are associated with induction and emergence of anesthesia. One 2013 study found “…a 17 percent reduction in the accuracy with which anesthesia residents detected changes in saturation on a pulse oximeter was found in a laboratory study simulating OR background noise.”
The Environmental Protection Agency (EPA) recommends background noise in hospitals be at 45 decibels (dB). Yet at least one study found OR trauma procedure noise at almost double that level. Another study found that “…OR trauma surgeries with an average noise level if 85 dB, distractions and interruptions occurred, on average, 60.8 times.”
While total elimination of noise in operating rooms and procedural units is not possible, TJC recommends several strategies/approaches to reduce the noise:
- "Implement a “no-interruption zone” (also known as “sterile cockpit”) during critical phases of a procedure, prohibiting nonessential conversation and activities.
- Consider measuring noise levels within the OR which will provide evidence for noise-reduction strategies, empirical data reflecting efficacy of such strategies, as well as real-time information to the OR team as to when noise levels are exceeding recommended levels.
- Educate staff on sources of noise, its impact to patient and staff safety, and noise reduction strategies.
- Consider equipment alternatives that produce less noise, whenever possible.
- Consider the physical environment and means for attenuating noise. For example, minimize dropping metal instruments into instrument trays.
- Consider simulation and training to enhance focused attention skills in the presence of continuous and intermittent noise and distractions.
- Consider simulation training to model strategies for reducing noise (e.g., equipment use, communication techniques, speaking up to reduce noise, etc.).”
TJC further recommends:
- Ensuring the organization reflects a culture of safety and that staff are empowered and encouraged to speak up and request silence.
- Have a policy and code of conduct that specifically address noise reduction and minimizing noise:
- How to enter/leave a room
- Reduction of unnecessary conversation
- Appropriate use of phones/pagers/wireless communication devices
- Use of music
- Conduct staff assessment to better understand resource needs for noise producing wireless technologies and then develop policies for those devices use in the OR environment.
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