To improve quality of care and reduce the risk of ventilator-associated pneumonia (VAP), we initiated a strict protocol for head of the bed elevation. Prior data has shown an 76% decrease in the incidence of ventilator associated pneumonia by employing a simple strategy of elevating the head of the bed >30°.1
An initial survey was done on all ventilated ICU patients twice a week for one month. A comprehensive education program for the ICU staff using a multi-modal approach was implemented. Didactic sessions were supplemented with the biweekly ICU newsletter as a reminder of this project. A bulletin board displayed data as it was collected. Finally, a line item was added to our admitting order set calling for head of bed elevation >30°. Only a single additional mouse click was required to complete the order using Computerized Physician Order Entry (CPOE).Patients who had injuries to their axial skeleton and those otherwise required to lie flat were excluded. Data was prospectively collected twice a week on all eligible patients to monitor compliance and progress over a 4 month evaluation period.
Percent compliance with head of bed elevationAt baseline, 28% of patients had head of the bed elevated >30°. Compliance rose significantly after the initiation of the education program to 69% and has progressively increased in the following two months.
An educational program can significantly improve ICU safety. CPOE facilitated compliance with this practice.CLINICAL IMPLICATION: Simple safety practices may be inconsistently adhered to in the intensive care unit. A comprehensive education program can significantly improve compliance with safety practices. CPOE provides a simple avenue to enhance compliance with safety goals. Mandatory orders for all ICU patients that incorporate established safety practices may further improve ICU patient safety.
W.T. McGee, None.