Clinicians' perception of head-of-bed elevation.
BACKGROUND
Head-of-bed elevation of 30 degrees to 45 degrees is important in preventing ventilator-associated pneumonia, but clinicians' perception and determination of head-of-bed elevation are not widely reported.


OBJECTIVE
To (1) document the accuracy of clinicians' perception of head-of-bed elevation, (2) document methods clinicians use to determine the head-of-bed angle, and (3) assess knowledge of recommended head-of-bed elevation.


METHODS
Clinicians (n = 175) viewed a simulated patient with head of bed elevated 30 degrees and elevation gauge concealed. They answered 3 questions: What is the level of the head of the bed? What head-of-bed elevation is associated with decreased incidence of ventilator-associated pneumonia? When providing care, how do you routinely determine the head-of-bed elevation?


RESULTS
Fifty percent of 89 registered nurses and 53% of 39 physicians identified head-of-bed elevation correctly (+/-5 degrees ). Head-of-bed elevation was perceived accurately by 86% of 21 respiratory therapists, 63% of 16 medical assistants, and 50% of 10 physical/occupational therapists. Ninety-five percent of nurses and respiratory therapists, 79% of physicians, 90% of physical/occupational therapists, and 46% of medical assistants correctly identified the head-of-bed angle associated with decreases in occurrence of ventilator-associated pneumonia. Techniques for determining the angle varied; 58% of respondents reported using the gauge.


CONCLUSIONS
Head-of-bed angle was perceived correctly by 50% to 86% of clinicians. Nurses tended to underestimate the angle, whereas other clinicians tended to overestimate. Nurses, respiratory therapists, and physical/occupational therapists showed the best understanding of the correct angle for minimizing occurrence of ventilator-associated pneumonia. Elevation gauges were most often used to determine the angle.
Hiner
Chad
C
Harborview Medical Center, Seattle, Washington 98125, USA. Chiner@u.washington.edu
Kasuya
Tomoyo
T
Cottingham
Christine
C
Whitney
JoAnne
J
D001513:Beds; D002983:Clinical Competence; D003422:Critical Care / Q000379:methods*; D004867:Equipment Design; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007318:Inservice Training / Q000379:methods; D008348:Manikins; D009726:Nurses / Q000592:standards / Q000706:statistics & numerical data; D056888:Patient Positioning; D010465:Perception; D010820:Physicians / Q000592:standards / Q000706:statistics & numerical data; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D014861:Washington