• Chad Hiner, Tomoyo Kasuya, Christine Cottingham, and JoAnne Whitney.
• Harborview Medical Center, Seattle, Washington 98125, USA. Chiner@u.washington.edu
• Am. J. Crit. Care. 2010 Mar 1;19(2):164-7.

BackgroundHead-of-bed elevation of 30 degrees to 45 degrees is important in preventing ventilator-associated pneumonia, but clinicians' perception and determination of head-of-bed elevation are not widely reported.ObjectivesTo (1) document the accuracy of clinicians' perception of head-of-bed elevation, (2) document methods clinicians use to determine the head-of-bed angle, and (3) assess knowledge of recommended head-of-bed elevation.MethodsClinicians (n = 175) viewed a simulated patient with head of bed elevated 30 degrees and elevation gauge concealed. They answered 3 questions: What is the level of the head of the bed? What head-of-bed elevation is associated with decreased incidence of ventilator-associated pneumonia? When providing care, how do you routinely determine the head-of-bed elevation?ResultsFifty percent of 89 registered nurses and 53% of 39 physicians identified head-of-bed elevation correctly (+/-5 degrees ). Head-of-bed elevation was perceived accurately by 86% of 21 respiratory therapists, 63% of 16 medical assistants, and 50% of 10 physical/occupational therapists. Ninety-five percent of nurses and respiratory therapists, 79% of physicians, 90% of physical/occupational therapists, and 46% of medical assistants correctly identified the head-of-bed angle associated with decreases in occurrence of ventilator-associated pneumonia. Techniques for determining the angle varied; 58% of respondents reported using the gauge.ConclusionsHead-of-bed angle was perceived correctly by 50% to 86% of clinicians. Nurses tended to underestimate the angle, whereas other clinicians tended to overestimate. Nurses, respiratory therapists, and physical/occupational therapists showed the best understanding of the correct angle for minimizing occurrence of ventilator-associated pneumonia. Elevation gauges were most often used to determine the angle.

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