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

Lyerla, F., LeRouge, C., Cooke, D. A., Turpin, D., & Wilson, L. (2010). A nursing clinical decision support system and potential predictors of head-of-bed position for patients receiving mechanical ventilation. American journal of critical care, 19(1), 39-47. <ref name="Lyerla">Lyerla, F., LeRouge, C., Cooke, D. A., Turpin, D., & Wilson, L. (2010). A nursing clinical decision support system and potential predictors of head-of-bed position for patients receiving mechanical ventilation. American journal of critical care, 19(1), 39-47. http://www.ncbi.nlm.nih.gov/pubmed/20045847 </ref>

===Background=== 
Being on medical ventilation presents greater risks for pneumonia at a rate of 8% to 28%. <ref name="Chastre">Chastre, J., & Fagon, J. Y. (2002). Ventilator-associated pneumonia. American journal of respiratory and critical care medicine, 165(7), 867-903. http://www.atsjournals.org/doi/abs/10.1164/ajrccm.165.7.2105078#.VO51SPnF_OE </ref> 
Prevention guidelines suggest elevation of the head of the bed 30 degrees to 45 degrees; however, this practice is underutilized.

===Objective===
Incorporate a nursing clinical decision support|clinical decision support system to remind practice of guideline.

===Methods===
Medium-sized hospital saw need for use of intervention based on underused guideline practices of elevating head of the bed between 30 degrees to 45 degrees. The study was divided into three phases: 1) prior to CDS implementation, month 1-2; 2) after CDS implementation, months 3-4; 3) after CDS implementation to assess for continued use, months 5-6. 

===Results===
The number of elevations of the head of the bed increased (mean 27.7 degrees) in phase 1 to (mean 31.7 degrees) in phase 2 and increased in phase 3 (mean 31.1 degrees) from phase 1. Characteristics of the patients who received elevations were tube-fed or with a pulmonary-related diagnosis that patients without enteral tube feedings. Patients with lower elevations had a gastrointestinal or other diagnosis or a body mass index (between 25.0 and 29.9) than others with a different BMI.

===Conclusions===
The study showed that a nursing CDS for patient elevation of the head of the bed increased elevation. 

===Comments===
This was an interesting article to read. CDS continue to show that something as simple as a reminder to practice a guideline for elevation of the head of the bed can make a difference. There evidence is there already for the guidelines and just needs to be implemented. It was also important to note that where this study took place, the hospital’s quality improvement department was able to identify the need for this intervention and that the CDS computer reminder was a way to improve on the need.

===References===

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[[category :reviews]]
[[category: CDS]]