A simple device to increase rates of compliance in maintaining 30-degree head-of-bed elevation in ventilated patients

Zev Williams, Rodney Chan, Edward Kelly

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

OBJECTIVE: To determine whether a highly visible device that clearly indicates whether the head-of-bed is adequately elevated would increase rates of compliance with head-of-bed elevation guidelines. DESIGN: A prospective, single-center, multi-unit, two-phase study. SETTING: Surgical, thoracic, trauma, and medical intensive care units. PATIENTS: Cohort of intubated patients. INTERVENTIONS: A 4-wk trial was performed. At the onset of the trial, nurses were reminded to maintain head-of-bed elevation >30 degrees. Over the subsequent 2 wks, head-of-bed elevations of intubated patient beds were measured. An Angle Indicator, designed to clearly display whether the head-of-bed was adequately elevated, was then placed on side rails of beds of ventilated patients, and head-of-bed elevation measurements were taken for an additional 2 wks. A survey was then handed out to nursing staff to assess satisfaction with the device. MEASUREMENTS AND MAIN RESULTS: A total of 268 bed measurements were made. The average head-of-bed elevation was 21.8 degrees on beds without the device (n = 166) and 30.9 degrees on beds with the device (n = 102; p < .005). When compliance is defined as a bed angle of ≥28 degrees, 23% of beds without the device were compliant while 71.5% of the beds with the device were compliant. The relative risk and odds ratio of having the device on a compliant bed were 2.2 and 9.25, respectively (p < .005). Seventy-two percent of nurses surveyed (n = 32) found it to be an improvement over existing methods, 88% found it helpful, and 84% would like it routinely used. CONCLUSIONS: The Angle Indicator improved rates of adherence to bed-elevation guidelines, and hospital staff found it helpful.

Original languageEnglish (US)
Pages (from-to)1155-1157
Number of pages3
JournalCritical Care Medicine
Volume36
Issue number4
DOIs
StatePublished - Apr 2008
Externally publishedYes

Fingerprint

Head
Equipment and Supplies
Odds Ratio
Nurses
Guidelines
Nursing Staff
Compliance
Intensive Care Units
Thorax
Wounds and Injuries

Keywords

  • Head-of-bed elevation
  • Infection prevention
  • Nosocomial infections
  • Ventilator-associated pneumonia

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

A simple device to increase rates of compliance in maintaining 30-degree head-of-bed elevation in ventilated patients. / Williams, Zev; Chan, Rodney; Kelly, Edward.

In: Critical Care Medicine, Vol. 36, No. 4, 04.2008, p. 1155-1157.

Research output: Contribution to journalArticle

Williams, Zev ; Chan, Rodney ; Kelly, Edward. / A simple device to increase rates of compliance in maintaining 30-degree head-of-bed elevation in ventilated patients. In: Critical Care Medicine. 2008 ; Vol. 36, No. 4. pp. 1155-1157.
@article{5c0bc007c36e4c738cc8bc1f81a5e1be,
title = "A simple device to increase rates of compliance in maintaining 30-degree head-of-bed elevation in ventilated patients",
abstract = "OBJECTIVE: To determine whether a highly visible device that clearly indicates whether the head-of-bed is adequately elevated would increase rates of compliance with head-of-bed elevation guidelines. DESIGN: A prospective, single-center, multi-unit, two-phase study. SETTING: Surgical, thoracic, trauma, and medical intensive care units. PATIENTS: Cohort of intubated patients. INTERVENTIONS: A 4-wk trial was performed. At the onset of the trial, nurses were reminded to maintain head-of-bed elevation >30 degrees. Over the subsequent 2 wks, head-of-bed elevations of intubated patient beds were measured. An Angle Indicator, designed to clearly display whether the head-of-bed was adequately elevated, was then placed on side rails of beds of ventilated patients, and head-of-bed elevation measurements were taken for an additional 2 wks. A survey was then handed out to nursing staff to assess satisfaction with the device. MEASUREMENTS AND MAIN RESULTS: A total of 268 bed measurements were made. The average head-of-bed elevation was 21.8 degrees on beds without the device (n = 166) and 30.9 degrees on beds with the device (n = 102; p < .005). When compliance is defined as a bed angle of ≥28 degrees, 23{\%} of beds without the device were compliant while 71.5{\%} of the beds with the device were compliant. The relative risk and odds ratio of having the device on a compliant bed were 2.2 and 9.25, respectively (p < .005). Seventy-two percent of nurses surveyed (n = 32) found it to be an improvement over existing methods, 88{\%} found it helpful, and 84{\%} would like it routinely used. CONCLUSIONS: The Angle Indicator improved rates of adherence to bed-elevation guidelines, and hospital staff found it helpful.",
keywords = "Head-of-bed elevation, Infection prevention, Nosocomial infections, Ventilator-associated pneumonia",
author = "Zev Williams and Rodney Chan and Edward Kelly",
year = "2008",
month = "4",
doi = "10.1097/CCM.0b013e318168fa59",
language = "English (US)",
volume = "36",
pages = "1155--1157",
journal = "Critical Care Medicine",
issn = "0090-3493",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - A simple device to increase rates of compliance in maintaining 30-degree head-of-bed elevation in ventilated patients

AU - Williams, Zev

AU - Chan, Rodney

AU - Kelly, Edward

PY - 2008/4

Y1 - 2008/4

N2 - OBJECTIVE: To determine whether a highly visible device that clearly indicates whether the head-of-bed is adequately elevated would increase rates of compliance with head-of-bed elevation guidelines. DESIGN: A prospective, single-center, multi-unit, two-phase study. SETTING: Surgical, thoracic, trauma, and medical intensive care units. PATIENTS: Cohort of intubated patients. INTERVENTIONS: A 4-wk trial was performed. At the onset of the trial, nurses were reminded to maintain head-of-bed elevation >30 degrees. Over the subsequent 2 wks, head-of-bed elevations of intubated patient beds were measured. An Angle Indicator, designed to clearly display whether the head-of-bed was adequately elevated, was then placed on side rails of beds of ventilated patients, and head-of-bed elevation measurements were taken for an additional 2 wks. A survey was then handed out to nursing staff to assess satisfaction with the device. MEASUREMENTS AND MAIN RESULTS: A total of 268 bed measurements were made. The average head-of-bed elevation was 21.8 degrees on beds without the device (n = 166) and 30.9 degrees on beds with the device (n = 102; p < .005). When compliance is defined as a bed angle of ≥28 degrees, 23% of beds without the device were compliant while 71.5% of the beds with the device were compliant. The relative risk and odds ratio of having the device on a compliant bed were 2.2 and 9.25, respectively (p < .005). Seventy-two percent of nurses surveyed (n = 32) found it to be an improvement over existing methods, 88% found it helpful, and 84% would like it routinely used. CONCLUSIONS: The Angle Indicator improved rates of adherence to bed-elevation guidelines, and hospital staff found it helpful.

AB - OBJECTIVE: To determine whether a highly visible device that clearly indicates whether the head-of-bed is adequately elevated would increase rates of compliance with head-of-bed elevation guidelines. DESIGN: A prospective, single-center, multi-unit, two-phase study. SETTING: Surgical, thoracic, trauma, and medical intensive care units. PATIENTS: Cohort of intubated patients. INTERVENTIONS: A 4-wk trial was performed. At the onset of the trial, nurses were reminded to maintain head-of-bed elevation >30 degrees. Over the subsequent 2 wks, head-of-bed elevations of intubated patient beds were measured. An Angle Indicator, designed to clearly display whether the head-of-bed was adequately elevated, was then placed on side rails of beds of ventilated patients, and head-of-bed elevation measurements were taken for an additional 2 wks. A survey was then handed out to nursing staff to assess satisfaction with the device. MEASUREMENTS AND MAIN RESULTS: A total of 268 bed measurements were made. The average head-of-bed elevation was 21.8 degrees on beds without the device (n = 166) and 30.9 degrees on beds with the device (n = 102; p < .005). When compliance is defined as a bed angle of ≥28 degrees, 23% of beds without the device were compliant while 71.5% of the beds with the device were compliant. The relative risk and odds ratio of having the device on a compliant bed were 2.2 and 9.25, respectively (p < .005). Seventy-two percent of nurses surveyed (n = 32) found it to be an improvement over existing methods, 88% found it helpful, and 84% would like it routinely used. CONCLUSIONS: The Angle Indicator improved rates of adherence to bed-elevation guidelines, and hospital staff found it helpful.

KW - Head-of-bed elevation

KW - Infection prevention

KW - Nosocomial infections

KW - Ventilator-associated pneumonia

UR - http://www.scopus.com/inward/record.url?scp=41649096699&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=41649096699&partnerID=8YFLogxK

U2 - 10.1097/CCM.0b013e318168fa59

DO - 10.1097/CCM.0b013e318168fa59

M3 - Article

VL - 36

SP - 1155

EP - 1157

JO - Critical Care Medicine

JF - Critical Care Medicine

SN - 0090-3493

IS - 4

ER -