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American Journal of Critical Care. 2010;19: 39-47 doi:10.4037/ajcc2010836
Copyright © 2010 by the American Association of Critical-Care Nurses.
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A Nursing Clinical Decision Support System and Potential Predictors of Head-of-Bed Position for Patients Receiving Mechanical Ventilation

By Frank Lyerla, RN, PhD, Cynthia LeRouge, PhD, CPA, Dorothy A. Cooke, RN, PhD, Debra Turpin, RN, MSN, ONC and Lisa Wilson, RN, BSN. Frank Lyerla is an assistant professor at Southern Illinois University Edwardsville, Edwardsville, Illinois. Cynthia LeRouge and Dorothy A. Cooke are associate professors at Saint Louis University, St Louis, Missouri. Debra Turpin is the chief nurse executive and Lisa Wilson is in risk management and safety at Alton Memorial Hospital, Alton, Illinois.

Corresponding author: Frank Lyerla, AH 3334, Southern Illinois University Edwardsville, Edwardsville, IL 62026-1066 (e-mail: flyerla{at}siue.edu).

Background Patients receiving mechanical ventilation are at high risk for pneumonia due to aspiration. Published guidelines recommend elevating the head of the bed 30° to 45°, if not contraindicated, to reduce risk, but this intervention is underused.

Objectives To facilitate incorporating evidence-based practice by improving positioning of patients receiving mechanical ventilation and to identify patient and nurse characteristics that predict use of the guideline.

Methods A modified interrupted time-series design was used. Data were collected on 43 patients and 33 nurses 3 separate times in a 12-bed intensive care unit at a medium-sized hospital. A total of 105 observations were recorded for analysis each time.

Results Mean elevations of the head of the bed increased significantly from phase 1 (27.7°) to phase 2 (31.7°) and from phase 1 to phase 3 (31.1°). Elevations were higher for tube-fed patients than for patients not given enteral tube feedings. Elevations were higher for patients with a pulmonary-related diagnosis and lower for patients with a gastrointestinal diagnosis than for patients with other diagnoses. Elevations were lower for patients with a body mass index between 25.0 and 29.9 (overweight) than for patients with other body mass index values. Nurse characteristics were not significant predictors of elevation.

Conclusion A nursing clinical decision support system integrated into a patient’s electronic flow sheet can increase nurses’ adherence to guidelines. Pulmonary and gastrointestinal diagnoses, body mass index, and tube feeding are predictors of elevation of the head of the bed.


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Copyright © 2010 by the American Association of Critical-Care Nurses.