During the COVID-19 pandemic, many innovative ideas have been implemented in an attempt to combat the disease. Coronavirus disease may progress to acute respiratory distress syndrome, a complex and multifaceted disease process that requires mechanical ventilation and demands timely intervention to achieve optimal patient outcomes.Pronation is the act of physically turning onto one’s abdomen, and its use as therapy has been recommended as management for severely ill patients with acute respiratory distress syndrome.1 Pressure injuries are one of the main complications of pronation therapy,2 particularly in patients receiving mechanical ventilation, who have an increased risk of pressure injury because they cannot redistribute their weight on their own. The National Pressure Injury Advisory Panel acknowledges these high-risk patients and created a tip sheet to help decrease the risk of pressure injury.3 We thought that by developing a packet that contained necessary prophylactic skin protection, we could mitigate pressure injuries that occur during prone positioning.Within our hospital’s critical care area, the clinical nurse specialist and clinical nurse educator collaborated to summarize organizational recommendations to prevent pressure injuries among prone patients receiving mechanical ventilation. We created an outline for nurses that included high-risk skin areas that need to be protected with foam when patients are in the prone position.The wound nurses at our hospital were consulted to review the content and offer further suggestions. They created a handout for the nursing staff that included a diagram of the patient and where nurses should place protective foam, the number and size of foam dressings needed, and when to change the foam and assess the skin (Figure 1). We collaborated with anesthetists, respiratory therapists, and intensivists to obtain feedback and ensure buy-in. This handout allowed all staff to standardize the approach for preventing pressure injury while a patient is prone.To ensure nurses had easy access to supplies, we decided to create a prepackaged kit including the handout and all of the preventive foam dressings that would be needed to prepare a patient for pronation therapy. Clinical nurses created these prevention packets, which were distributed to the units caring for patients with COVID-19.As nursing and therapy staff continued to use pronation therapy, we needed to ensure staff adjusted the patient’s body slightly and repositioned their head (Figure 2). The writing on the window panes was difficult to interpret and took up a great deal of space. A small group, including a clinical nurse, clinical nurse specialist, and 2 rehabilitation therapists, created a flyer to standardize scheduling for repositioning patients (Figure 3); this flyer was posted outside of the rooms. Using the standardized template, we were able to operationalize a concrete schedule for assessing and repositioning patients for the duration of their pronation therapy.Throughout this pandemic, hospital staff have had to become savvy to continue to provide stellar care to their patients. Nursing staff’s critical thinking and decision-making can be influenced by many factors such as fellow nurses, patients, and unit workflow.4 By collaborating and assessing the flow of patients with COVID-19, our team lived up to this challenge, developing innovative ideas to improve patient outcomes. Adding the pressure injury prevention packets to the nursing workflow has been extremely helpful in ensuring a standard approach to prevent pressure injuries among our prone patients receiving mechanical ventilation.After the rollout of the pressure injury prevention packets, nursing staff shared their thoughts informally about the intervention. Nurses thought it was convenient to have all items necessary for preventing pressure injury available in 1 packet, which made them efficient when preparing their patients. Specifically, the staff appreciated the instructional diagram that assisted them in appropriately placing the preventive foam pads.No pressure injuries occurred on high-risk skin areas in our patients throughout the implementation of the pressure injury prevention packet. Using the Plan, Do, Study, Act method and reviewing pressure injury data, we modified the packets to include foam dressings and instructions for preventing pressure injury on previously unknown susceptible skin areas such as the bridge of the nose.Wound nurses were promptly consulted during the care of all prone patients and collaborated on protecting patient-specific high-risk skin areas. The interdisciplinary COVID-19 care team developed a comprehensive view of skin protection while caring for prone patients as the pressure injury prevention packets were implemented. Although the main focus of this intervention was to optimize prone positioning for patients with COVID-19, the concept has expanded to all patients requiring pronation therapy.
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Open Access
Sep 2, 2021
Marco Pignatti + 7
