Observational study of head of bed elevation adherence using a continuous monitoring system in a medical intensive care unit.

BACKGROUND Head of bed elevation ≥ 30° reduces ventilator-associated pneumonia in mechanically ventilated patients, but adherence is variable and difficult to monitor continuously. Unlike many clinical variables, head of bed elevation is not electronically displayed or monitored with audible alarms. HYPOTHESIS Continuous monitoring of head of bed elevation with audible alerts and visual cues when the elevation is < 30° will improve adherence by 15%. METHODS Head of bed elevation was continuously monitored and recorded on a central monitoring station and displayed on the bedside monitor of 16 of 24 medical intensive care unit beds. Manual bedside checks were performed twice daily at varying times. RESULTS Continuous head of bed angle was available from 98 of 313 (31%) patient beds over a 7.5 month period, representing 322 of 1,373 mechanical ventilator days (24%). Continuous monitoring was performed for 7,720 hours, 5,542 hours with the data displayed on bedside monitors and 2,178 hours with the data available only from central monitors. Head of bed elevation was ≥ 30° for 76% of the hours when the data were displayed on bedside monitors, and for 61% of hours when it was not (P < .001, odds ratio = 2.3, 95% CI 2.0-2.6). Intermittent bedside checks for head of bed elevation ≥ 30° found 97 ± 2% adherence. CONCLUSIONS Real-time monitoring of head of bed elevation is feasible, and when combined with audible alarms and visual cues, improves ≥ 30° elevation adherence. Intermittent bedside checks over-estimate actual adherence.