Implementing a Multidisciplinary Prone Positioning Team

Abstract

The coronavirus disease 2019 pandemic has escalated clinical needs while interrupting regular processes and straining resources. Striving to deliver optimal care to infected patients with respiratory failure, Rush University Medical Center in Chicago created a multidisciplinary team to provide manual prone positioning safely and efficiently. Team members' experiences, which they shared through a survey, help to illustrate the advantages of a multidisciplinary approach and suggest opportunities to enhance the effectiveness of such a team.

Optimizing nursing workload in the intensive care unit during the COVID-19 pandemic: Planning prone positioning

“…Despite the general consideration that the prone position is a low-cost procedure, positioning and repositioning of critically ill patients is a complex and time consuming task, requiring a significant amount of health care staff [ 10 , 11 ]. Several reports describe that prone positioning involves a dedicated team of five to seven trained providers [ [12] , [13] , [14] ]. Moving a patient from supine to prone and back, should always guarantee an adequate safety level, for both patients and the acting health care providers.…”

COVID-19 Lessons Learned: Prone Positioning With and Without Invasive Ventilation

“…21,38 PP training is largely an institution-developed process, and several teams have reported the use of simulation to prepare for manual PP. 38,[41][42][43] Some have also reported utilizing the material provided by the authors of the PROSEVA study, 8 which includes a video demonstrating the procedure. 38,43 In our own experience, we utilized a process based on our previous research to prepare for manual PP, 44 which consisted of using a healthy volunteer to simulate an intubated patient to practice the process of manual PP.…”

“…PP teams consisted of various professionals, including RTs, nurses, certified registered nurse anesthetists, occupational therapists, physical therapists, and technologists. 38,[41][42][43]45,46 The overall goals of PP teams were to provide support to the bedside RTs and nurses, standardize the PP process, and to reduce AEs related to PP. 38,41 Whereas publications regarding the use of PP teams primarily describe the development and experiences related to their implementation, some patterns have consistently emerged with the use of PP teams.…”

“…38,[41][42][43]45,46 The overall goals of PP teams were to provide support to the bedside RTs and nurses, standardize the PP process, and to reduce AEs related to PP. 38,41 Whereas publications regarding the use of PP teams primarily describe the development and experiences related to their implementation, some patterns have consistently emerged with the use of PP teams. First, the use of health care professionals who are not typically involved in the PP process for critically ill patients (eg, occupational therapists, physical therapists, non-ICU nurses, and technologists) is feasible and safe when adequate training is provided.…”

“…1) were used to improve efficiency. 38,[41][42][43]45 PP teams may not be necessary during non-pandemic times. Still, their concept illustrates how institutions can use training, standardization, and resource re-allocation to provide essential services during patient surge situations (pandemic or other disasters).…”