A Teaching Plan and Toolkit to Improve Quiet at Night HCAHPS score in a Medical-Surgical Unit

• Problem: Noise may have undesirable effects on patients, most notably interfering with their sleep at night. Implementing a quiet-time schedule and other evidence-based practices can increase patients’ satisfaction. • Context: This quality improvement teaching plan was initiated in a 25-bed unit in a large rural community hospital to increase patients’ HCAHPS satisfaction scores for quietness at night. The project involved educating staff members in a medical-surgical unit where patients require constant monitoring. The unit leadership has been concerned about patient-satisfaction scores falling below the 24th percentile. • Interventions: To meet its goals by the end of the performance year 2020, the unit developed a nursing- and patient-centered approach, including a quiet-at-night team to test a new quietness toolkit consisting of a presentation on the unit’s current HCHAPS scores, a microsystem gap analysis using audits, assessment of staff members’ baseline knowledge, one-on-one staff education by designated team members, and bedside huddles to remind nurses and evaluate patient satisfaction. • Measures: The process measures that were included pre-COVID included a pre and post-test to provide immediate feedback on the effectiveness of the training. Comparison of the benchmarks and baseline data with run and control charts and monitoring of the quiet at night HCAHPS score will be conducted post-COVID on a quarterly basis. • Results: The coronavirus pandemic delayed the implementation of several components of this implementation and teaching plan. Initial results from a small pilot of 5 nightshift nurses indicated that education interventions including a toolkit may be effective in decreasing noise at night especially between the hours of 12:00 am and 4:00 am. • Conclusions: Improving staff awareness can reduce unnecessary night-time noise in hospitals. A quietness-at-night teaching plan and toolkit for staff members has the potential to increase the relevant HCAHPS score and enhance patient sleep quality