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

Area of Science:

• Critical Care Medicine
• Respiratory Therapy
• Infectious Disease Management

Background:

• Prone positioning is a recognized intervention for acute respiratory distress syndrome (ARDS).
• The COVID-19 pandemic necessitated rapid adaptation of prone positioning into awake self-prone positioning for critically ill patients.
• Hospitals sought to implement this new process to manage a surge of COVID-19 inpatients and prevent respiratory failure progression.

Purpose of the Study:

• To assess the feasibility and safety of implementing awake self-prone positioning in a large healthcare system during the COVID-19 pandemic.
• To evaluate the integration of this novel intervention into routine care for COVID-19 patients.

Main Methods:

• A comprehensive literature review of 22 case reports, standards, and studies informed the development of an awake self-prone positioning guideline.
• Multimodal education, including a concise guideline and real-time nursing support, was employed for implementation in critical care and COVID-19 units starting April 2020.
• Data were retrospectively collected from electronic medical records to evaluate the procedure's adoption.

Main Results:

• From March 18 to August 5, 2020, 1000 COVID-19 admissions were recorded.
• Among 272 patients requiring high-flow nasal cannula, 111 (41%) had documented use of awake self-prone positioning.
• The guideline was successfully integrated into practice and became an established part of COVID-19 care.

Conclusions:

• Nurses demonstrated rapid adaptation to utilizing awake self-prone positioning for hypoxic patients.
• This intervention offers a potential strategy for hospitals to manage patient care during surges and maintain patients outside of intensive care units.
• Awake self-prone positioning is now an established component of care for COVID-19 patients within the healthcare system.