title: A nursing clinical decision support system and potential predictors of head-of-bed position for patients receiving mechanical ventilation.
abstract: BACKGROUND
  Patients receiving mechanical ventilation are at high risk for pneumonia due to aspiration. Published guidelines recommend elevating the head of the bed 30 degrees to 45 degrees , if not contraindicated, to reduce risk, but this intervention is underused.
  
  
  OBJECTIVE
  To facilitate incorporating evidence-based practice by improving positioning of patients receiving mechanical ventilation and to identify patient and nurse characteristics that predict use of the guideline.
  
  
  METHODS
  A modified interrupted time-series design was used. Data were collected on 43 patients and 33 nurses 3 separate times in a 12-bed intensive care unit at a medium-sized hospital. A total of 105 observations were recorded for analysis each time.
  
  
  RESULTS
  Mean elevations of the head of the bed increased significantly from phase 1 (27.7 degrees ) to phase 2 (31.7 degrees ) and from phase 1 to phase 3 (31.1 degrees ). Elevations were higher for tube-fed patients than for patients not given enteral tube feedings. Elevations were higher for patients with a pulmonary-related diagnosis and lower for patients with a gastrointestinal diagnosis than for patients with other diagnoses. Elevations were lower for patients with a body mass index between 25.0 and 29.9 (overweight) than for patients with other body mass index values. Nurse characteristics were not significant predictors of elevation.
  
  
  CONCLUSIONS
  A nursing clinical decision support system integrated into a patient's electronic flow sheet can increase nurses' adherence to guidelines. Pulmonary and gastrointestinal diagnoses, body mass index, and tube feeding are predictors of elevation of the head of the bed.
authors.affiliation: Southern Illinois University Edwardsville, 62026-1066, USA. flyerla@siue.edu
authors.forename: Frank
authors.initials: F
authors.lastname: Lyerla
authors.forename: Cynthia
authors.initials: C
authors.lastname: LeRouge
authors.forename: Dorothy A
authors.initials: DA
authors.lastname: Cooke
authors.forename: Debra
authors.initials: D
authors.lastname: Turpin
authors.forename: Lisa
authors.initials: L
authors.lastname: Wilson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020000:Decision Support Systems, Clinical; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007362:Intensive Care Units / Q000592:standards; D008297:Male; D008875:Middle Aged; D009732:Nursing Care / Q000592:standards; D019370:Observation; D056888:Patient Positioning / Q000451:nursing* / Q000592:standards; D053717:Pneumonia, Ventilator-Associated / Q000451:nursing* / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D017010:Reminder Systems; D012121:Respiration, Artificial / Q000009:adverse effects / Q000451:nursing*