765

Abstract

Introduction: In mechanically ventilated patients, maintaining head of bed (HOB) elevation >30 degrees significantly decreases the risk of ventilator associated pneumonia (VAP). Compliance with this practice, however, is poor in many intensive care units (ICU). Furthermore, little is known about how nurses determine HOB angle. The purpose of this study was to determine a) compliance with proper HOB elevation in our unit, b) its association with bed type by comparing beds with different angle indicators, c) whether bed type impacted the accuracy of HOB angles recorded in electronic medical records (EMR), and d) if nurses used available angle indicators. Hypothesis: Hospital bed type impacts maintenance of proper HOB elevation. Methods: An independent observer assessed the HOB angle three times daily for a total of 264 observations in 33 consecutive postoperative cardiac surgery patients on mechanical ventilation. Observed angles were a) compared to corresponding values charted by the bedside nurse, and b) stratified by beds with side of the bed indicators (SBI, n = 76) vs. under the bed indicators (UBI, n = 188). Observed measurements of HOB angle were determined by using the built-in angle indicator for each of the two bed types. HOB angle <30 degrees was considered non-compliant. Finally, by polling 33 of 72 (46%) nurses, we determined whether they used the angle indicators or estimated to assess HOB elevation. Results: HOB angle was observed to be <30 degrees in 20% of observations. Noncompliance was observed more frequently in UBI beds vs. SBI beds (23% vs. 12%, p = 0.04). Nurse charting in the EMR was accurate to within 2.5 degrees in 50% of SBI beds but only 20% of UBI beds (p < 0.0001). Finally, although 67% of nurses used the SBI, only 27% used the UBI, and 6% estimated, never using either bedside indicator. Conclusions: Overall compliance with appropriate HOB elevation for ventilated patients in our ICU is suboptimal. However, compliance was significantly better in SBI beds. Most nurses do not always use available bedside indicators to determine HOB elevation. We speculate that uniform placement of easily visible indicators and nurse education could significantly improve compliance with this performance metric.