Friday April 4, 2008
A simple device to increase rates of compliance in maintaining 30-degree head-of-bed elevation in ventilated patients

A study published in April 2008 of 'Critical Care Medicine' 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. It was a prospective, single-center, multi-unit, two-phase study of 268 intubated patients.

First phase: At the onset of the trial, nurses were reminded to maintain head-of-bed elevation more than 30 degrees. Over the subsequent 2 wks, head-of-bed elevations of intubated patient beds were measured.

Second Phase: 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.

Results:

• The average head-of-bed elevation was 21.8 degrees on beds without the device, and
• 30.9 degrees on beds with the device

When compliance is defined as a bed angle of more than / = 28 degrees,

• 23% of beds without the device were compliant while
• 71.5% of the beds with the device were compliant

Nursing satisfaction

• 72% of nurses surveyed 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.

The Angle Indicator consists of a piece of glossy photographic printer paper cut into a pie-slice wedge. The base of the paper has a stripe of green and then red. A silk suture hangs from the apex of the wedge to its base and a steel nut is tied at the distal end of the suture. The angle indicator is placed on the side rail of the hospital bed such that when the bed is elevated to 30 degrees, the weight hangs at the junction between red and green. When the bed is elevated >30 degrees, the weight hangs in the green zone, and when the elevation is less than 30 degrees, the weight hangs in the red zone.

References:

1. A simple device to increase rates of compliance in maintaining 30-degree head-of-bed elevation in ventilated patients - Critical Care Medicine. 36(4):1155-1157, April 2008.