Development, Implementation, and Impact of a Proning Team During the COVID-19 Intensive Care Unit Surge

Abstract

Background: Prone positioning has been used as an intervention to improve oxygenation in critically ill patients with acute respiratory distress syndrome. During the COVID-19 pandemic, resources were even more limited given a surge in acute respiratory distress syndrome patients, which outstripped intensive care unit (ICU) capacity at many institutions.Local Problem: The purpose of this article is to describe the development and implementation of a proning team during the surge in ICU patients with COVID-19 and to measure the impact of the program through surveys of staff involved. Methods/Interventions: A proning protocol and educational plan was developed. A proning team of redeployed staff was created. A survey of ICU registered nurses and proning team members was used to evaluate the benefits and challenges of the proning team.Results: The proning team was successful in safely performing more than 300 proning and supinating maneuvers for critically ill patients. There is overwhelming support within the institution for a proning team for future COVID-19 surges.Discussion: The development and implementation of the proning team happened quickly to assist with the surge of patients and off-load work from ICU registered nurses. Despite the success of the proning team, more clearly defined roles and expectations, as well as additional education, are needed to further enhance teamwork and workflow.Conclusions: Creation of the proning team was a creative use of resources that helped manage the large and medically complex patient population. This work may serve as a guide to other health care institutions.

Lessons Learned in Mechanical Ventilation/Oxygen Support in Coronavirus Disease 2019

“…Small, observational studies published early in the pandemic 59 , 60 , 61 , 62 showed improved oxygenation through prone positioning, and further observational data described reduced mortality in those patients on mechanical ventilation who were proned 63 , 64 , 65 . Proning protocols were developed, and some centers created specific proning teams to provide relief for the core intensive care team 66 , 67 , 68 . Intermittent prone positioning became standard of care for intubated patients with ARDS secondary to COVID-19, mainly based on literature showing reduction in mortality in non-COVID ARDS 54 , 55 , 56 .…”

Using a Learning System Approach to Improve Safety for Prone-Position Ventilation Patients

“…Issues identified included unsafe staffing ratios, lack of education or resources to safely prone patients, and knowledge deficits related to sedation and neuromuscular blockade utilization. Recognition of these gaps in care and subsequent use of the data to drive process improvement initiatives, such as implementing PPV turning teams and providing opportunities for education and simulation, required the use of a learning system to inform patient safety efforts 10 …”

Interprofessional practice in the Intensive Treatment Unit during the Covid-19 pandemic; the reflections of an Advanced Practitioner Radiographer

“…Many departments sought to create specific teams to undertake procedures such as proning, line insertions and intubation, thus allowing specific professional skills to be channelled to the area's most in need. 18 , 19 , 20 , 25 , 51 , 53 Open communication within teams along with a clear understanding of the common goal, exemplified teamworking at its best. 52 The nature of the ITU environment demands transparent communication between all members of the interprofessional team.…”

“…Many studies recognised the need for dedicated proning teams and a proning champion. 18 , 19 , 20 In many cases, staff redeployed into ITU during the pandemic were predominantly involved in the practice of proning patients. 18 , 19 , 21 …”