A nursing clinical decision support system and potential predictors of head-of-bed position for patients receiving mechanical ventilation.

BACKGROUND: Patients receiving mechanical ventilation are at high risk for pneumonia due to aspiration. Published guidelines recommend elevating the head of the bed 30 degrees to 45 degrees , 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 degrees ) to phase 2 (31.7 degrees ) and from phase 1 to phase 3 (31.1 degrees ). 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.