In August 2019, a multidisciplinary prone committee was developed in a collaborative effort to address the transition of prone positioning of an adult patient with Acute Respiratory Distress Syndrome (ARDS) from utilizing a mechanical rotation bed to a process of manual prone positioning.
It was identified that a manual prone positioning process provided a faster response to meet the needs of the adult intensive care patient population presenting with acute respiratory failure secondary to hypoxia. Manual prone positioning was also cost-effective.
To develop and implement a process to manually prone an adult patient required a coordinated committee effort utilizing the knowledge, skills and expertise of pulmonary critical care physicians, Medical Intensive Care Unit (MICU) staff RNs, MICU unit leadership, respiratory therapists (RTs) and the MICU Clinical Nurse Specialist (CNS).
The committee expanded to include all ICU-CNS nurses, wound care and ostomy nurses (WOCN), physical therapy, occupational therapy and pharmacy. The WOCNs were consulted as expert opinion was necessary to address the patient’s skin integrity.
The prone committee, chaired by a respiratory therapist, divided the workload and, from March 1 to May 27, 2020, developed an operational policy, “Prone positioning for the mechanically ventilated patient in the Adult Intensive Care Unit,” as well as the following:
- Prone patient module - order set for physicians and advance practice providers (APP)
- Education and training plan on the “Manual Prone Position for Patients with ARDS” with a step-by-step instructional checklist and training validation competency
- An instructional video on how to safely manually prone and supine the critically ill patient
- Prone patient documentation in EPIC
- A prone team that was utilized to manually prone patients in all adult ICUs, once the COVID-19 pandemic exceeded expectations
During the period of March 2020 through May 2020, the RUSH Institutional Review Board (IRB) approved a single center, retrospective observational cohort study. The sample size was 234 intubated adult ICU patients diagnosed with COVID-19. It was reported that 196/234 or (84%) underwent manual prone positioning.