Implementation and Assessment of a Proning Protocol for Nonintubated Patients With COVID-19

D'Souza, Felicia R.; Murray, John P.; Tummala, Sandeep; Puello, Frances; Pavkovich, David S.; Ash, Daniel; Kelly, Stephanie B. H.; Tyker, Albina; Anderson, Daniela; Francisco, Mary A.; Pierce, Nicole L.; Cerasale, Matthew T.

INTRODUCTION: The COVID-19 pandemic has caused over 1,250,000 deaths worldwide. With limited therapeutic options, proning nonintubated patients emerged as a safe and affordable intervention to manage hypoxemia. METHODS: A proning protocol to identify and prone eligible patients was implemented. Patients were encouraged to self-prone for 2–3 hours, 3 times daily. Investigators created educational materials for nurses and patients and developed a COVID-19–specific proning order within the electronic health record (EHR). Investigators completed an 800-person retrospective chart review to study the implementation of this protocol. RESULTS: From March 22, 2020, to June 5, 2020, 586 patients were admitted to the COVID-19 floor. Of these patients, 42.8% were eligible for proning. Common contraindications were lack of hypoxia, altered mental status, and fall risk. The proning protocol led to a significant improvement in provider awareness of patients appropriate for proning, increasing from 12% to 83%, as measured by placement of a proning order into the EHR. There was a significant improvement in all appropriate patients documented as proned, increasing from 18% to 45% of eligible patients. CONCLUSIONS: The creation of an effective hospital-wide proning protocol to address the exigencies of the COVID-19 pandemic is possible and may be accomplished in a short period of time.