A simple device to increase rates of compliance in maintaining 30-degree head-of-bed elevation in ventilated patients

OBJECTIVE: To determine whether a highly visible device that clearly indicates whether the head-of-bed is adequately elevated would increase rates of compliance with head-of-bed elevation guidelines. DESIGN: A prospective, single-center, multi-unit, two-phase study. SETTING: Surgical, thoracic, trauma, and medical intensive care units. PATIENTS: Cohort of intubated patients. INTERVENTIONS: A 4-wk trial was performed. At the onset of the trial, nurses were reminded to maintain head-of-bed elevation >30 degrees. Over the subsequent 2 wks, head-of-bed elevations of intubated patient beds were measured. An Angle Indicator, designed to clearly display whether the head-of-bed was adequately elevated, was then placed on side rails of beds of ventilated patients, and head-of-bed elevation measurements were taken for an additional 2 wks. A survey was then handed out to nursing staff to assess satisfaction with the device. MEASUREMENTS AND MAIN RESULTS: A total of 268 bed measurements were made. The average head-of-bed elevation was 21.8 degrees on beds without the device (n = 166) and 30.9 degrees on beds with the device (n = 102; p < .005). When compliance is defined as a bed angle of ≥28 degrees, 23% of beds without the device were compliant while 71.5% of the beds with the device were compliant. The relative risk and odds ratio of having the device on a compliant bed were 2.2 and 9.25, respectively (p < .005). Seventy-two percent of nurses surveyed (n = 32) found it to be an improvement over existing methods, 88% found it helpful, and 84% would like it routinely used. CONCLUSIONS: The Angle Indicator improved rates of adherence to bed-elevation guidelines, and hospital staff found it helpful.