Awake Self-Prone Positioning: Implementation During the COVID-19 Pandemic.

Allicock, Karen A; Coyne, Danielle; Garton, Anna N; Hare, Erin C; Seckel, Maureen A

BACKGROUND Prone positioning is a well-known beneficial intervention for patients with acute respiratory distress syndrome. As the COVID-19 pandemic emerged, hospitals rapidly adapted prone positioning for acutely ill patients into a new process: awake self-prone positioning. Could a large health care system safely and rapidly implement awake self-prone positioning in COVID-19 units to prevent respiratory failure from progressing among a surge of inpatients? REVIEW OF EVIDENCE The team extensively reviewed the literature. Using evidence from 22 case reports, peer-reviewed standards, and studies, they developed an awake self-prone positioning guideline. IMPLEMENTATION The guideline was implemented in April 2020 in critical care and COVID-19 units. Multimodal education included a concise guideline and real-time support from intensive care unit nurses, clinical nurse specialists, and nursing professional development specialists. EVALUATION Awake self-prone positioning was a new procedure, and relevant data were obtained from the electronic medical record. From March 18 to August 5, 2020, 1000 COVID-19-related admissions occurred; 272 patients had a high-flow nasal cannula, 111 (41%) of whom had documentation of awake self-prone positioning. SUSTAINABILITY This guideline is now an established part of COVID-19 care and has been integrated into practice in units caring for patients with the disease. CONCLUSIONS Nurses adapted quickly to using awake self-prone positioning as a plan of care for hypoxic patients. This practice may help hospitals adjust care delivery for these patients and effectively maintain patients in non-intensive care units. (Critical Care Nurse. Published online April 13, 2021).