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How bedside feedback improves head-of-bed angle compliance for intubated patients
Journal article   Peer reviewed

How bedside feedback improves head-of-bed angle compliance for intubated patients

Geb W Thomas
IISE transactions on healthcare systems engineering, Vol.7(2), pp.73-80
04/03/2017
DOI: 10.1080/24725579.2017.1281851
PMCID: PMC6557428
PMID: 31187082
url
https://www.ncbi.nlm.nih.gov/pmc/articles/6557428View
Open Access

Abstract

One clinical defense against ventilator-associated pneumonia is maintaining the head-of-bed angle of ventilated patients above 30°. Most previous studies of head-of-bed angles using electronic monitoring have recorded compliance rates of less than 50%. The purpose of this study was to determine how bedside feedback of the head-of-bed angle affects bed angles set by healthcare workers. Electronic inclinometers were installed on 22 beds in an intensive care for a period of 38 days. Intubated patients were randomly assigned into two cohorts. One cohort received a graphical display of the bed angle adjacent to the in-room computer display. The head-of-bed angle of each intubated patient was continuously recorded, yielding 1,528 h of observation. The mean head-of-bed angle was 28.78° for beds with displays and 25.50° for those without, a significant difference. The most significant effects were for angles near 30°. Beds in the display cohort were three times as likely to be in a compliant position as beds in the no-display cohort. The results suggest that electronic bedside feedback improves head-of-bed angle compliance by raising angles slightly below the compliance threshold into compliance. This result may support studies of how compliant bed-angle protocols affect health outcomes.
 head-of-bed monitoring Protocol adherence ventilator-associated pneumonia wireless sensors

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