Effect of standardized orders and provider education on head-of-bed positioning in mechanically ventilated patients.
OBJECTIVE
Semirecumbent head-of-bed positioning in mechanically ventilated patients decreases the risk of developing ventilator-associated pneumonia (VAP). The purpose of this study was to determine whether the addition of a standardized order followed by the initiation of a provider education program would increase the frequency with which our patients were maintained in the semirecumbent position.


METHODS
Prospective, pre-, and postintervention observational study.


METHODS
A tertiary care, U.S. Army teaching hospital.


METHODS
Mechanically ventilated medical and surgical intensive care unit patients.


METHODS
The first intervention involved the addition of an order for semirecumbent head-of-bed positioning to our intensive care unit order sets. This was followed 2 months later with a second intervention, which was a nurse and physician education program emphasizing semirecumbent positioning.


RESULTS
Data regarding head-of-bed positioning were collected on 100 patient observations at baseline and at 1 and 2 months after each of our interventions. The mean angle of head of bed increased from 24 +/- 9 degrees at baseline to 35 +/- 9 degrees (p <.05) 2 months after the addition of the standard order. The percentage of observations with head of bed >45 degrees increased from 3% to 16% 2 months after the standardized order (p <.05). Two months after our provider education program, the mean angle of the head of bed was 34 +/- 11 degrees and the percentage of patients with head of bed >45 degrees was 29% (p = NS compared with values after the first intervention). Data collected 6 months after completion of our education programs showed that these improvements were maintained.


CONCLUSIONS
Standardizing the process of care via the addition of an order specifying head-of-bed position significantly increased the number of patients who were placed in the semirecumbent position. In an era of cost-conscious medicine, interventions that utilize protocols and education programs should be emphasized.
D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007318:Inservice Training / Q000592:standards; D007362:Intensive Care Units; D008297:Male; D011015:Pneumonia, Aspiration / Q000517:prevention & control*; D011187:Posture; D011336:Probability; D011361:Professional Competence; D011380:Programmed Instructions as Topic / Q000592:standards*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods*; D012131:Respiratory Insufficiency / Q000628:therapy; D016896:Treatment Outcome