Frequency of oral care and positioning of patients in critical care: a replication study

Oral care and head-of-bed elevation are interventions to decrease risk of aspiration pneumonia in hospitalized patients. In a previous study, nurses' self-reports of how often they performed oral care did not match documented provision of such care.

To replicate the original study and estimate instrument reliability.

A cross-sectional design was used, and survey data from nursing personnel and bedside observational data from 9 intensive care units were collected.

A total of 181 surveys (47%) were returned, and data were collected from 436 bedsides. Reported frequencies of oral care and use of oral care products differed between nonintubated and intubated patients (P< .001). The mean documented frequency of oral care for nonintubated patients was 1.8 (SD 1.5); self-reported frequency was 3 (SD 2.4). The mean documented frequency of oral care for intubated patients was 3.3 (SD 1.8); self-reported frequency was 4.2 (SD 2.1). Documented oral care frequency differed by unit (P = .006) and intubation status (P < .001). Mean observed head-of-bed position was 38 degrees (SD 24 degrees ) for nonintubated patients and 23 degrees (SD 12 degrees ) for intubated patients (P < .001). Intubation status, but not unit, affected observed head-of-bed position (P < .001). Three survey items had adequate reliability evidence (r = 0.70). Interrater reliability for bedside data collection was 96% or greater.

Despite inadequate estimates of survey reliability, findings generally were comparable to results of the original study; nurses report more frequent oral care than is documented. Intensive care nurses elevate the head of patients' beds in accordance with self-reports.