Abstract
Purpose: Positioning mechanically ventilated patients in an adequate semi-recumbent position is a low cost and apparently easy applied measure to prevent new VAP. We performed an unannounced audit to compare the actual backrest angle with the target backrest angle of 30-45 degrees, assess whether compliance was better in patients whose bed had a built-in bedside protractor, and document difficulties reported when failing to achieve the target backrest angle.
Methods: From 1/3/2007 to 30/6/2007, unannounced ad hoc inspections were made on patients receiving mechanical ventilation in the intensive care unit. During inspections, the angle of elevation of bed was formally measured by a manual technique using a hand-held protractor. The nurse at bed-side was also asked to estimate the angle of elevation of bed without referring to the built-in protractor and interviewed with a structured questionnaire.
Results: From 1/3/2007 to 30/6/2007, inspections were made on 295 occasions. The median angle of backrest elevation was 25 degrees (interquartile range [IQR]: 20 to 30 degrees). The median angle of elevation estimated by the nurse at the bed-side was 30 (IQR: 20 to 30 degrees), (p <0.001). Semi-recumbent positions meeting the 30 degree minimum target angle were observed on only 120 (41%) occasions. Reasons provided for failing to achieve the target angle included incorrect estimation of the backrest angle and interference of the semi-recumbent position with nursing procedures and nursing inconvenience.
Conclusions: This audit showed that the minimum target semi-recumbent position of 30 degrees was achieved only 40% of the time in an academic intensive care unit. Nurses at bedside consistently overestimated the angle of elevation of bed, and the presence of a built-in bedside protractor was not associated with a greater compliance with the target backrest elevation angle. Strictly enforced pro
tocols, education programs for nurses and doctors and regular audit may improve compliance with backrest elevation targets.
Thomas ST Li, Gavin M. Joynt, Hing Y. So, Charles D. Gomersall, Florence HY Yap
