Using In Situ Simulation to Develop a Prone Positioning Protocol for Patients With ARDS

Abstract

Background Acute respiratory distress syndrome carries a 40% mortality rate. Prone positioning remains underused owing to clinicians’ low degree of confidence, concern about the risk of adverse outcomes, and lack of staff competency training. Local Problem and Purpose A prone positioning protocol and educational program were needed in an intensive care unit to achieve compliance with best practices for treating acute respiratory distress syndrome patients. Methods An initial survey was conducted to measure staff confidence and competency in prone positioning. A literature review was performed, and a plan-do-study-act approach was used to develop a protocol through in situ simulation involving mock patients. A training video and a simulation scenario using a high-fidelity manikin were developed to facilitate staff education. Staff were surveyed again after training. Interventions During the simulation scenario, interdisciplinary clinicians learned to apply the protocol and resupinate the patient during a simulated emergency. The training video was later used for “just in time” education minutes before actual prone positioning events. Results A total of 25 critical care nurses, 11 respiratory therapists, and 10 physicians completed the initial survey and simulation training. The survey showed that staff lacked confidence and competency in prone positioning. Staff demonstrated competence during the simulation sessions, and posttraining surveys indicated increased confidence. After the educational program, prone positioning was successfully used for 6 critically ill acute respiratory distress syndrome patients. Conclusions In situ simulation and interdisciplinary collaboration increase standardization of high-risk, underused procedures, improving staff confidence and competence as well as patient safety.

Skin damage prevention in the prone ventilated critically ill patient: A comprehensive review and gap analysis (PRONEtect study)

“…[described in article] Implementation strategies include face-to-face education sessions, a video a quick reference sheet and web-based education. [no link to material] Montanaro [ 27 ] 2021 Mount Sinai Morningside Hospital, New York, USA. Using In Situ Simulation to Develop a Prone Positioning Protocol for Patients With ARDS.…”

Critical Care Nurse Needs You! Behind the Scenes of Peer Review

“…I also monitor CCN's submissions to avoid having 2 similar manuscripts under review at the same time. For example, at the start of the COVID-19 pandemic, it was important to publish articles on prone positioning, yet we wanted to ensure that each article covered a different aspect of prone positioning, such as nursing management, 7 protocol development, 8 use of a proning device, 9 and awake self-proning. 10 For every newly submitted manuscript, 1 of 3 decisions are made before peer review: (1) reject, (2) return to the author for revisions, or (3) retain for peer review.…”

Reducing Facial Hospital-Acquired Pressure Injuries Related to Prone Positioning in the Intensive Care Unit

“…In the critical care setting, patients with ARDS and related conditions are often mechanically ventilated and placed in the prone position to further assist with increasing oxygen exchange to maximize ventilation and perfusion 6,7. During the global pandemic, as many as 67% of COVID-19 patients developed ARDS; this life-threatening complication carries a reported mortality rate of up to 40% 8,9. A 2023 study of mortality data during the first year of the COVID 19 pandemic in the United States reported an approximately 5-fold increase in deaths attributed to ARDS 10.…”

“…When the body is in supine position, the chest wall, heart, and adjacent organs naturally rest upon the lungs. When ARDS occurs, compression of the lungs by these organs, as well as an increase in lung weight due to edema or pulmonary fluid, further impairs ventilation and perfusion of oxygen 9. Placing these patients in a prone position alleviates compromised alveoli and improves oxygen exchange.…”