Effect of the Comprehensive Unit-Based Safety Program (CUSP) on the Compliance With Head of Bed Elevation in the Intensive Care Unit

Abstract

PURPOSE: Institute of heath care improvement (IHI) recommends to elevate the head end of the patients' bed between 30 and 45 degrees as an intervention to prevent ventilator associated pneumonia (VAP). In our unit the rate of compliance with the head of bed elevation was 60% in September 2009. This was low in comparison to IHI recommended rate 95%. Design: Prospective, observational study. Our goal was to exceed the 95% recommended compliance. METHODS: We provided a focused education to all nursing and medical staff in intensive care on the importance of applying the following VAP prevention bundle: 1) Head end elevation 30-45 degrees, 2) Weaning protocol. 3) Hand hygiene washing technique, 4) Frequency of mouth care, 5) Correct placement of suctioning tubing, 6) Disposal of water used for oral and nasal suction every 12 hour The compliance with the above bundle was measured on monthly basis and the results were reported on a four weekly basis in comprehensive unit based safety program (CUSP) meeting. An action plan, which included nursing education and frequent feedback on one to one basis, was implemented and its effect was monitored. A link nurse was assigned to collect the data regarding the above quality indicators included in the bundle. Thirty randomly selected patients were audited each month (n = 210). RESULTS: The study showed a marked improvement of the compliance with head of bed elevation from 60% to 90% over seven months (figure 1). The difference was statistically significant (P < 0.0001). CONCLUSION: Involvement of unit leadership in comprehensive unit based safety program, followed by comprehensive audit, education and feedback to the medical staff results in improved compliance with elevation of head of bed in mechanically ventilated patient in intensive care unit. CLINICAL IMPLICATIONS: This intervention may reduce ventilator associated pneumonia.