Quality Improvement Initiative to Reduce Pediatric Intensive Care Unit Noise Pollution With the Use of a Pediatric Delirium Bundle

Kawai, Yu; Weatherhead, Jeffrey; Traube, Chani; Owens, Tonie; Shaw, Brenda E.; Fraser, Erin J.; Scott, Annette; Wojczynski, Melody R.; Slaman, Kristen L.; Cassidy, Patty M.; Baker, Laura A.; Shellhaas, Renée A.; Dahmer, Mary K.; Shever, Leah L.; Malas, Nasuh; Niedner, Matthew

doi:10.1177/0885066617728030

Cited by 43 publications

(51 citation statements)

References 55 publications

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“…Intensive care units are particularly noisy areas of hospitals . Neonatal units have average sound pressure levels of 48–61 dB for up to 95% of the time , paediatric units average 53–73 dB and adult units are 53–59 dB . The unit at the John Radcliffe Hospital when measured in 2012 had daytime averages of 58 dB at the desk and 60 dB adjacent to the patient .…”

Section: Discussionmentioning

confidence: 99%

Mapping sources of noise in an intensive care unit

et al. 2019

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Summary Excessive noise in hospitals adversely affects patients’ sleep and recovery, causes stress and fatigue in staff and hampers communication. The World Health Organization suggests sound levels should be limited to 35 decibels. This is probably unachievable in intensive care units, but some reduction from current levels should be possible. A preliminary step would be to identify principal sources of noise. As part of a larger project investigating techniques to reduce environmental noise, we installed a microphone array system in one with four beds in an adult general intensive care unit. This continuously measured locations and sound pressure levels of noise sources. This report summarises results recorded over one year. Data were collected between 7 April 2017 and 16 April 2018 inclusive. Data for a whole day were available for 248 days. The sound location system revealed that the majority of loud sounds originated from extremely limited areas, very close to patients’ ears. This proximity maximises the adverse effects of high environmental noise levels for patients. Some of this was likely to be appropriate communication between the patient, their caring staff and visitors. However, a significant proportion of loud sounds may originate from equipment alarms which are sited at the bedside. A redesign of the intensive care unit environment to move alarm sounds away from the bed‐side might significantly reduce the environmental noise burden to patients.

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Section: Discussionmentioning

confidence: 99%

Mapping sources of noise in an intensive care unit

et al. 2019

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“…Researchers and clinicians are beginning to recognize the importance of sedation protocols (Curley et al, 2015), sleep promotion (Kawai et al, 2017), early mobility (Betters et al, 2017), and increased family presence (Harrison, 2010) in pediatric intensive care, however the impact of these interventions on the incidence and duration of delirium remains unknown. Attempts to facilitate widespread implementation of these interventions and increase the prevention and treatment of delirium in pediatric populations will not be successful without the leadership and collaboration of bedside nurses.…”

Section: Relevance To Clinical Practicementioning

confidence: 99%

“…Children less than 5 years of age appear to be especially at risk for delirium, as are children who are developmentally delayed, have a high severity of illness, are mechanically ventilated, or receive benzodiazepines (Holly, Porter, Echevarria, Dreker, & Ruzehaji, 2018;Mody et al, 2018;Silver et al, 2015;Smith et al, 2017;Traube, Silver, Gerber, et al, 2017). While efforts have been made to implement sedation protocols (Curley et al, 2015), sleep promotion (Kawai et al, 2017), early mobility (Betters et al, 2017), and increased family presence (Harrison, 2010) in pediatric intensive care, it remains unknown if there is a resulting decrease in the incidence or duration of delirium. Long-term effects of pediatric delirium are unknown, but children with delirium have an increased duration of mechanical ventilation, PICU length of stay, and risk for mortality (Silver et al, 2015;Smith et al, 2017;Traube, Silver, Gerber, et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

The Life Course Health Development Model: A theoretical research framework for paediatric delirium

Kalvas

2019

Journal of Clinical Nursing

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Aims and Objectives: The purpose of this article is to create a framework for future research through application and critique of the Life Course Health Development Model to the phenomenon of pediatric delirium. Background: Delirium in the pediatric intensive care unit is associated with increased duration of mechanical ventilation, length of stay, and mortality. Nurses are uniquely positioned at the bedside to identify, prevent, and treat delirium. An understanding of the potential long-term consequences of pediatric delirium is necessary to provide impetus for nursing research and practice change. The Life Course Health Development Model is a valuable tool when considering the multiple mechanisms and processes through which the experience of delirium could affect a child's life trajectory. Design: Critical review of the literature through application and critique of the Life Course Health Development Model in the context of pediatric delirium. Gaps in the current understanding of pediatric delirium, as well as future directions for research and practice, are discussed. Methods: The seven core principles of the model are considered in the context of pediatric delirium. Each of the principles has the potential to further understanding of pediatric delirium and identify areas for future inquiry. This discussion leads to a critique of the ability of the model to lead future research and practice change. Conclusions: The Life Course Health Development Model depicts a process in which the acute and severe stress of critical illness leads to maladaptive neurologic changes that contribute to the development of delirium and impair a child's life trajectory. Relevance to Clinical Practice: By emphasizing the potential lifelong consequences for critically ill children who experience delirium, this application of the Life Course Health Development Model will stimulate discussion, research, and practice change among pediatric clinicians and researchers.

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“…Data on the baseline acute rehabilitation practices in PICUs internationally will likely illuminate specific areas for targeted research. 20 Building on the ABCDEF bundle, we are learning that optimizing sedation, integrating sleep promotion, and preventing delirium go hand in hand with creating healing environments for infants and children too, [21][22][23] and the SCCM Pediatric Collaborative data are forthcoming. We are investigating ICU-acquired weakness in children and modalities for monitoring and diagnosis, [24][25][26] and have established the PICU framework for postintensive care syndrome.…”

Section: See Related Article P 25mentioning

confidence: 99%