The implementation of a noise reduction bundle in the intensive care unit: A qualitative process evaluation

Area of Science:

• Healthcare quality improvement
• Clinical practice implementation science

Background:

• Noise in intensive care units (ICUs) negatively impacts patient outcomes and staff well-being.
• Implementing noise reduction strategies is crucial for improving the ICU environment.

Purpose of the Study:

• To identify factors influencing the adoption and sustained use of a noise reduction bundle in daily ICU practice.
• To understand healthcare professionals' experiences with implementing noise reduction interventions.

Main Methods:

• Seven semi-structured focus group interviews were conducted with 31 nursing staff and physicians.
• Data were transcribed, coded, and analyzed using Flottorp's checklist to identify determinants of practice.
• Collaborative analysis by multiple researchers ensured comprehensive data interpretation.

Main Results:

• 37 factors influencing noise reduction bundle application were identified.
• Facilitators included phased implementation, clear communication, regular theme addressing, routine building, supportive materials, reminders, training, technical assistance, engaged leadership, key nurses, and feedback.
• Barriers included limited urgency, lack of outcome expectancy, poor adherence, limited issue-raising, absence of noise norms, and unsuitable environments.

Conclusions:

• Successful ICU noise reduction necessitates structured implementation addressing contextual and cultural factors.
• Engaged leadership and feedback promoted adoption, while limited urgency and absence of shared noise norms hindered sustainability.
• An integrated approach combining technical solutions, behavioral strategies, team ownership, and open communication is essential for effective noise reduction.