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

Abstract

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? 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. 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. 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. 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. 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)