title: Hospital Bed Type, the Electronic Medical Record, and Safe Bed Elevation in the Intensive Care Setting.
abstract: In mechanically ventilated patients, head of bed (HOB) elevation above 30° decreases the risk of ventilator-associated pneumonia. The research team studied (a) compliance with proper HOB elevation in their cardiac surgical intensive care unit, (b) the accuracy of HOB angles recorded in the electronic medical record (EMR), and (c) the effect of bed type on (a) and (b). Nurses were polled to discover how HOB angles were measured in practice. HOB angles were compliant in 80% of observations. Compliance was more frequent in beds with side-of-bed angle indicators (SBI) than beds with under-bed angle indicators (UBI; 88% vs 77%, P = .04). Charting in the EMR was accurate in 50% of SBI bed observations but only 20% of UBI bed observations (P < .0001). Sixty-seven percent of nurses used the SBI; 27% used the UBI; 6% used estimation alone. Though compliance was suboptimal, compliance and EMR accuracy were significantly associated with bed type. Bedside indicators are underutilized.
authors.affiliation: Johns Hopkins Hospital, Baltimore, MD zwfitch@gmail.com.
authors.forename: Zachary W
authors.initials: ZW
authors.lastname: Fitch
authors.affiliation: Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Damon
authors.initials: D
authors.lastname: Duquaine
authors.affiliation: Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Rika
authors.initials: R
authors.lastname: Ohkuma
authors.affiliation: Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Schneider
authors.affiliation: Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Glenn J R
authors.initials: GJ
authors.lastname: Whitman
mesh_terms: D001513:Beds / Q000592:standards*; D006348:Cardiac Surgical Procedures; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D009741:Nursing Staff, Hospital / Q000706:statistics & numerical data; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*
keywords: cardiac surgery; electronic medical record; head-of-bed angle; heart surgery; mechanical ventilation; quality improvement