Wireless Head of Bed Sensor Deployment for Monitoring Ventilator-Associated Pneumonia Prevention Protocols

Jon Myers Dept: Mechanical and Industrial Engineering Mentor: Professor Geb Thomas With: Philip Polgreen, David Cannistraro, Derik Falk, Seb Surom, David Campbell, Ted Herman
Objective:
Create and deploy monitors to measure bed tilt angle in the Medical Intensive Care Unit and study the effects it has on Ventilator-Associated Phenomena. Determine whether bed angle feedback to the health care professionals increases protocol compliance rates.

Preparation for Deployment:

Each Bed Tilt Monitor contains a dual axis accelerometer. Before deployment in the Medical Intensive Care Unit the device was calibrated by inclining the Bed Tilt Monitor to angles between 0-45 degrees in increments of 5 degrees. The raw value was then recorded and graphed in relationship to the sine of the angle (Figure 2).

Results:
The system initially operated for 4.5 days and collected 9.5 ventilator-days of data. An additional half day could have been collected, but for various challenges. The Bed Tilt Monitor batteries discharged after 4 days, despite lab tests indicating they should last a week. Several Nexus 7s were inadvertently turned off. Figure 3 illustrates the head of bed angle for one of the ventilated patients.

Background:
Ventilator-associated pneumonia (VAP) is a common infection acquired in intensive care units. Drakulovic et al. (1999) observed that intubated patients who were completely flat had significantly higher VAP and mortality rates than those patients with a head of bed angle elevated to 45. Thus, American Thoracic Society, the Infectious Disease Society of America recommend positioning ventilated patients in a semi recumbent position with bed backrest elevation between 30 and 45.

Approach:
A Nexus 7 tablet along with a Bed Tilt Monitor communicate wirelessly with each other though radio signals (Figure 1) . A message is sent whenever the Bed Tilt Monitor is moved or when it has been idle for 8 minutes. The tablet then sorts the incoming data and decodes the message into date, time, angle X, angle Y, battery level, and room number. Once decoded the room number and angle are displayed using our android app. The data is then stored in a database that can be later accessed for analysis.

Figure 2: Calibration Graph Figure 3: Data from Bed Tilt Monitor 23

Stage 1 of Deployment:
The objective of the first specific aim was to collect baseline data, no visual feed back was given to the nurse. The first trial of stage one took place during the dates of 7/87/19. Throughout the Medical Intensive Care Unit (MICU) bed monitors were placed on 21 out of the 26 available beds. Four Nexus 7s were placed at 4 out of the 5 nurses stations.

For Future Work:

- Prepare and execute stages 2 and 3 - Update Nexus 7 app to provide clear feedback - Battery charging station - Create larger display for nursing station (Figure 4) - Redesign case to allow for easier access to components (Figure 5)

Stage 2 of Deployment:
The objective of this specific aim is to determine whether immediate feedback will overcome cognitive lapses and slips by providing a system designed to immediately flag these behaviors as they occur to give the person adjusting the bed a chance to correct his or her action.

Stage 3 of Deployment:
The objective of this specific aim is to determine whether feedback delivered to the nurses station and to doctors and administrators will alleviate both rule-based and knowledge-based mistakes that cause nurses to set the head-of-bed angle to less than desired angles. To address this aim, we will extend the in-room wireless network from the sensors in the patient rooms to support displays at the nurses station so that all the nurses can see the 24-hour tilt history of all the patients in their wing of the MICU.

Figure 1: Equipment

Figure 4: Nurse Display

Figure 5: New Case

Acknowledgements: This research was supported by grant number RO3 HS021558-01A1 from the Agency for Healthcare Research and Quality (AHRQ).