When you can't just cover your ears: Protecting yourself from harmful noise in your pharmacy

“Music, ringing telephones, intercom messages and other noisy distractions are a hindrance to the pharmacist's concentration,” wrote the Association professionnelle des pharmaciens salariés du Québec (APPSQ) in its 2022 guide to the organization of work in community pharmacy. “In community pharmacy, noise comes from everywhere,” observed pharmacist Pierre-Marc Gervais, who presented a conference on the subject, titled “Overcoming irritants in community pharmacies to optimize well-being,” as part of the APPSQ's Congrès 2024. Additional noise comes from robotized systems, such as pill counters, computer systems and ventilation. “These are omnipresent background noises, but we're less aware of them. One of the challenges of community pharmacy is that we work in an open-plan environment, and there are no barriers to mitigate these noises.”Jean-François Bussières, clinical professor in the faculty of pharmacy at the Université de Montréal and former Head of the Pharmacy Department at CHU Sainte-Justine, has been working on this subject for almost 15 years. His research, the first of its kind, has enabled him to develop solutions for limiting noise pollution in pharmacies. His first sound-mapping of the hospital's pharmacy department dates back to 2011. “The premises were relatively cramped given the growth in activities, such as the increase in dispensing and sterile preparations,” he said. A room designed for three or four people was holding up to 15, creating more noise."Despite different configurations, the challenges are the same in community pharmacy. “Dispensaries require regular air changes for sterile preparations. In a normal office, we'll change the air five or six times an hour. In a pharmacy, it's 25, 30 times an hour. This ventilation makes noise and creates friction.” Fridges are also a major source of noise pollution, he added.Noise controlAccording to the latest APPSQ survey, 70% of pharmacists say they experience constant voice interruptions from patients, and 85% from technical staff during their work. Gervais, now president of Axxess International, a customs brokerage and international freight forwarding company, is no stranger to this reality. “When I was working in the community, I found it hard to avoid parallel conversations, as we tend to have ears and eyes everywhere.” Intercoms are also extremely distracting, especially when the pharmacy is located within another business, says Karine Patry, pharmacist and inspector with the Ordre des pharmaciens du Québec (OPQ). “I met a pharmacist who was interrupted every 15 minutes,” she recalled.The problem is that as clinical activities in the pharmacy become more complex, the need for concentration increases—but so do the sources of interruptions: impatient patients banging against the Plexiglas window, a colleague asking questions about a task, the opening of the appointment booking system. All this has physical and mental repercussions that can go as far as burnout, warned Gervais. “We risk doing our work superficially if we can't concentrate properly.”But simple solutions can be put in place to protect the ears of pharmacists and technical staff alike, he believes.Possible solutions“You can control the source of the noise, by adjusting the volume of the radio and telephone, or by moving the robots out of the dispensing area. We could also install screens made from materials that avoid reverberation,” he suggested. On this point, the Plexiglas panels dating from the COVID era elicit mixed opinions from the two experts. Gervais sees them as insulating the laboratory, while Bussières sees them as exacerbating the noise coming from the dispensary by reverberating it.Other possible solutions include redirecting the ringing of the telephone to a headset for the person in charge of patient triage or appointments or allowing professionals to perform tasks requiring concentration in closed offices or at workstations isolated from the laboratory area.Keeping labs, or compounding areas, away from patients is an option that at first glance contradicts community pharmacies' desire for accessibility, Patry acknowledged. “We've brought labs back to patients, at the expense of pharmacists' ability to concentrate.” The OPQ inspector acknowledges, however, that the order's recommendations in terms of noise currently only concern pharmacies inside healthcare institutions. “In the community, we focus more on the confidentiality of exchanges. Maybe we'll change that.” This means rethinking the way community pharmacies operate. “Instead of trying to fit a lab into the smallest possible area to maximize floor space, we should be thinking about giving more space to the pharmacy, to offer employees a more appropriate working environment,” said Gervais.Noise mappingAt CHU Sainte-Justine, management took the results of noise mapping into account when laying out the department's new premises, into which the teams moved in 2022. “We isolated the validation and fridges from the rest to preserve the teams' concentration. We now have a room we call the aquarium, with noise-reducing walls,” said Bussières. This was an opportunity for him to conduct a new sound mapping of 30 sites in the department. The result: Ambient noise in the pharmacy now fluctuates between 40 and 71 decibels A (dBA)—well above the recommended threshold of 35 to 40 dBA for a workplace where activities require a high level of concentration.Although there are still areas of significant noise pollution, such as the sterile preparation rooms, mainly due to the mandatory ventilation alone, which can reach 40 dBA, Bussières is pleased to have reduced noise levels in the department. We have identified seven areas where noise has been reduced by 3 dBA, which represents a 50% reduction in sound energy,” he said. “The human ear doesn't necessarily perceive this, but it makes a huge difference to stress and stimulation.”For example, levels measured in 2022 were around 52.1 ± 5.0 dBA in the medication bagging area, compared with 58.8 ± 4.0 before the move to the new premises; 45.9 ± 1.2 dBA compared with 55.0 ± 3.4 dBA for the medication in/out shelf area; or 51.3 ± 2.9 dBA in 2022 compared with 56.9 ± 5.2 dBA previously in the outpatient prescription entry and validation and medication preparation area.Not yet a priorityAt a time when many hospital pharmacy departments and pharmacies are rethinking the organization of their spaces to facilitate the deployment of the new clinical activities envisaged by Bill 67, is noise management a priority? Not yet, say Gervais and Bussières. “We're more concerned with optimizing travel and workflows,” noted Gervais.The issue of noise is rarely addressed in the choice of materials or in the management of working hours. Yet pharmacies would do well to do so, he said, in the interests of optimizing efficiency and profitability.“Efforts are being made to prevent musculoskeletal disorders and injuries, but not to reduce noise,” added Bussières.But managers are making an effort, according to the Association des bannières et des chaînes de pharmacies du Québec (ABCPQ). “Noise management in pharmacies is an essential consideration, and companies are integrating acoustic principles into the design and layout of their spaces,” said its General Manager Hugues Mousseau.Some chains and banners have opted for sound-absorbing materials such as soundproofing tiles on suspended ceilings or vinyl tiles on floors; rethought the physical organization of premises by integrating multi-zone audio systems to modulate the sound ambience according to the space; and reviewed the location of partitions and ceiling heights. Others have chosen to implement virtual queues or automated call management systems to reduce repeated ringing, while adopting equipment with a low-noise footprint.“Despite these efforts, there is still room for improvement,” he said.This article has been translated from its original French and first appeared on our sister site Profession Santé.

When you can't just cover your ears: Protecting yourself from harmful noise in your pharmacy

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