Proning Teams Overcome Challenges in ICU during Pandemic

The pandemic put patient proning front and center for intensive care unit (ICU) nurses juggling the complex care demands of critically ill COVID-19 patients.

Proning is an evidence-based, lifesaving procedure, during which healthcare staff place patients on their stomachs to increase oxygen to the lungs. The maneuver might sound easy, but prone positioning in the ICU is a complex and risky procedure requiring careful and synchronized coordination among a team of trained providers.

To seamlessly integrate proning into its 11 already stressed ICUs (including five created in 2020 to accommodate a COVID-19 surge), nurses at Massachusetts General Hospital (MGH) implemented a proning team. They published their experience with developing and implementing the proning program in June ’21 in AACN Advanced Critical Care.

The dedicated proning team ensured patient and staff safety, while allowing ICU nurses to focus on other aspects of patient care during the initial surge from early April to early June 2020, according to study co-author and proning team lead, Karen Miguel, MM-H, RN, CPPS, Staff Specialist for Patient Care Services Quality, Safety, and Practice at MGH.

Johns Hopkins Hospital also implemented a proning team during the first COVID-19 wave in 2020, according to Deborah Sherman, MSN, RN, Interim Chief Nursing Informatics Officer for Johns Hopkins Medicine and Clinical Director for Clinical Informatics at Johns Hopkins Hospital.

“The team was a blessing,” said Sherman. “When the surge started back in March 2020, our step-down unit received about 12 new admissions all in the same shift — all had to be intubated and all had to be proned. The medical ICU staff would help as much as they could, but they were overwhelmed. So, I said out loud what others probably were thinking: ‘We should have a prone team like we have a code team (an emergency response team).’ Our leadership agreed.”

Proning Team Elements

Clinical nurses from the medical ICU or the ICU step down units led the prone team response at Johns Hopkins.

“That person takes charge and gives directions to each of the participants, letting them know what to do,” Sherman said. “That nurse also provides leadership for the whole [proning] process.”

Johns Hopkins tapped physical and occupational therapists as prone team members, which worked out well during the initial surge because many of Johns Hopkins Medicine ambulatory clinics had shut down and some of those therapists could be redeployed to the prone team.

“They are always good with mobility, so they were perfect candidates for the team and loved being part of it,” said Sherman.

About 70 MGH operating room (OR) nurses, OR assistants, and outpatient physical therapists with knowledge of prone positioning and experience with safe mobilization and positioning were selected for the program.

The proning team was available 24 hours a day, seven days a week. MGH had two teams of four during the day and evening shifts, and a team of four on the night shift. Each interdisciplinary team had at least one OR nurse and one physical therapist. A resource nurse served as liaison between the ICUs and the proning …read more

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