Development of a Prone Team and Exploration of Staff Perceptions During COVID-19

Abstract

Objective: As intensive care unit bed capacity doubled due to COVID-19 cases, nursing leaders created a prone team to support labor-intensive prone positioning of patients with COVID-related acute respiratory distress syndrome. The goal of the prone team was to reduce workload on intensive care teams, standardize the proning process, mitigate pressure injuries and turning-related adverse events, and ensure prone team safety. Methods: Staff were trained using a hybrid learning model focused on prone-positioning techniques, pressure injury prevention, and turning-related adverse events. Results: No adverse events occurred to patients or members of the prone ream. The prone team mitigated pressure injuries using prevention strategies. The prone team and intensive care unit staff were highly satisfied with their experience. Conclusion: The prone team provided support for critically ill patients, and team members reported feeling supported and empowered. Intensive care unit staff were highly satisfied with the prone team.

Optimizing nursing workload in the intensive care unit during the COVID-19 pandemic: Planning prone positioning

“…Despite the general consideration that the prone position is a low-cost procedure, positioning and repositioning of critically ill patients is a complex and time consuming task, requiring a significant amount of health care staff [ 10 , 11 ]. Several reports describe that prone positioning involves a dedicated team of five to seven trained providers [ [12] , [13] , [14] ]. Moving a patient from supine to prone and back, should always guarantee an adequate safety level, for both patients and the acting health care providers.…”

“…Some authors reported as a feasible strategy the creation of dedicated pronation teams, which are a group of trained health care providers like critical care or operating theatre nurses, physical therapists, intensivists and even medical students [ 11 , 19 , 20 ]. The main goals of such pronation teams are to collaborate with the ICU staff, reducing their burden, positioning critically ill patients through a standardised procedure and reducing turning-related adverse events [ 14 , 20 ]. Pronation teams are generally composed of three to five providers and should be available 24/7.…”

“…Pronation teams are generally composed of three to five providers and should be available 24/7. For example, Miguel et al described their experience in a large research hospital, reporting the activity of up to five prone teams every day (three to four providers each) during the peak of the first wave of the pandemic [ 14 ]. It should be considered that implementing one or more pronation teams involves a significant amount of human resources and might be difficult for smaller hospitals or in case of staff shortage.…”

Innovative Partnership Between Intensive Care Unit Nurses and Therapists to Care for Patients With COVID-19

“…Evidence suggests that hospitals responded to the influx of patients during the COVID-19 pandemic by implementing similar teams. Miguel et al 15 described the implementation of a prone positioning team comprising operating room nurses, operating room assistants, and outpatient PTs. That team completed 228 prone positionings and 211 supine positionings during 8 weeks.…”

COVID-19 Lessons Learned: Prone Positioning With and Without Invasive Ventilation

“…Despite considerable evidence supporting PP for severe ARDS, before the COVID-19 pandemic, PP was underutilized. [38][39][40] The underutilization of PP is attributed to several factors including clinicians' judgment of hypoxemia severity, concern for hemodynamic instability, concern for obesity, and misconceptions of high risk of adverse events (AEs), among others. 38,40 However, information gained from the initial Italian and Chinese experiences with COVID-19, along with the expected rapid influx of patients in hypoxemic respiratory failure, forced many teams to quickly begin PP training in preparation for the pandemic.…”