The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

A COMPARISON BETWEEN PATIENTS HEIGHTS RECORDED IN THE ELECTRONIC MEDICAL RECORD AND THE PATIENTS ACTUAL MEASURED HEIGHTS: THE IMPACT ON THE SETTING OF TIDAL VOLUME

Donald L. Bellerive, Scott Kopec, Rachel Carragher, Luanne Hills, Scott Leonard, Earl Dyer, Pam Leclaire, Larry Owens, Paul Alger, Patrick Dowd, Sharon Pare, Patricia Lemire, Thomas Canedy, Darlene Levasseur, Thomas Collins, Kathy McLane, Debbie Hendrickson; Respiratory Care, UMass Memorial Health Care, Worcester, MA

Background: Patient heights and weights are important patient data frequently entered into the medical record from a variety of sources including patient self reporting, family reporting, actual measurements, and MD or RN estimates. Heights used to calculate IBW impacts medical decisions such as medication dosages and tidal volume. Because not all heights and weights entered into the electronic medical record are a result of a direct measurement, there is that possibility that errors could be made in treatments based on the inaccuracy of the recorded heights. Recommended tidal volume is based on IBW, which in turn is calculated from the actual height. We conclude that some patients are placed on incorrect tidal volumes based on inaccurate height data entered into the electronic medical record. Methods: We reviewed 100 consecutive, intubated patients admitted to 7 adult ICUs ( medical, surgical, trauma, and CT surgery). Patients were excluded if on pressure cycled modes of ventilation such as Bilevel or PCV. Patient heights recorded in the electronic medical record were used to calculate recorded IBW. All patients were then measured and this measured height was then used to calculate measured IBW. Recorded and measured heights and recorded and measured IBWs were then compared. Tidal volumes based on recorded IBWs were then compared to tidal volumes based on measured IBWs. Results: Of the 100 patients, 3 were excluded due to being on pressure cycled ventilation. Recorded heights were on average 1.3 inches (2.9cm) higher than the measured heights (P=0.001). Tidal volumes based on recorded IBW were on the average 25.4ml higher than tidal volumes based on the measured IBW (P<0.001). In 30 of 97 patients (30.9%) the set tidal volumes based on their recorded IBW were more than 50ml higher than the predicted tidal volumes based on their measured IBW. In only 21 patients (21.6%) were the recorded heights identical to the measured heights. Conclusions: Heights recorded in the patient’s record are inaccurate nearly 80% of the time. Using recorded heights instead of the actual measured heights results in incorrect calculations of IBW and results in incorrect tidal volumes. Recorded heights tend to be higher than actual heights leading to the use of larger than required tidal volumes. These larger tidal volumes based on inaccurately recorded heights can potentially result in worsening acute lung injury and a higher mortality in patients with ARDS or ALI. Sponsored Research - None

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