Healthcare Workers Proning A Patient
"You have to remember that these are people fighting for their lives. And so, when we open up a little more lung, that's the difference between life and death." - Physician advocate for proning
Atlas Lift Tech, Inc. (Atlas) and Mobility is Medicine (MiM) joined forces in 2016 to integrate evidence-based mobility practices that are safe for staff and patients across the continuum of care. In the Spring of 2020, the team made a concerted effort to help healthcare workers combat the COVID-19 pandemic. Educating and advocating for mobility solutions and the associated benefits for healthcare providers and patients became a top priority. Now more than ever, mobility has become a matter of life and death.
As part of their mutual goal to promote safe patient mobility practices for healthcare workers and patients, Atlas and MiM saw a dire need to share timely, relevant, evidence-based mobility practices and free resources for professionals during this crisis. As a result, MiM, supported by Atlas, produced a 3-part on-demand video series called, “Proning Safely: A Three-Piece Puzzle”. Proning is not a new concept or medical practice. In fact, it has been used in patients with Acute Respiratory Distress Syndrome (ARDS) to improve oxygenation and prevent complications of ventilator-induced lung injury for the past 30 years. However, the use of prone positioning is now considered frontline therapy! In this video series, experts provide insights to define the patient most likely to respond to prone positioning, identify the time frame in which to initiate therapy, and to determine the appropriate time spent in the prone position. Additionally, safe patient handling strategies are shared on how to turn and sustain the patient in a prone position. All this insight and so much more is shared in the video series by top industry experts who bring their vast experience with them.
Meet the Experts
Kathleen Vollman (MSN, RN, CCNS, FCCM, FCNS, FAAN) started working with patients placed in the prone position during the mid-1980s. She is a clinical nurse specialist, consultant and entrepreneur who has widely published and lectured (both nationally and internationally) on a variety of critical care subjects. She is a subject matter expert on a variety of pulmonary, critical care, prevention of healthcare-acquired injuries, work culture and sepsis recognition and management. In 2009 Kathleen was inducted into the American Academy of Nurses (AACN). She co-authored the procedure for placing patients in the prone position for the "AACN Procedure Manual for High Acuity, Progressive, and Critical Care" (7th edition) in 2016.
Dr. Joyce Black (PhD, RN, FAAN) has always had an interest in wound and pressure injury healing and prevention. Early in her career, she discovered dangerous types of wounds and factors causing them. Dr. Black is so passionate about the topic that she requires graduate students she sponsors to work on a thesis related to wound and pressure injury care. Dr. Black is currently an associate professor at the University of Nebraska Medical Center College of Nursing. She is certified in wound healing, plastic surgical nursing and is a fellow in the American Professional Wound Care Association. Dr. Black is also the current President of the National Pressure Ulcer Advisory Panel and chairman of the NPUAP's task force to redefine pressure ulcer staging.
Dr. Gail Powell-Cope (PhD, APRN, FAAN) is a passionate advocate and champion of safe patient handling and mobility. As both caregiver and researcher, she witnessed firsthand the devastating impact of what happens when a safe patient handling mobility program is not implemented and nurtured: caregivers become patients and patient outcomes significantly decline. Dr. Powell-Cope has had an extensive career as a nurse, researcher, and mentor. While she was the Director for the Tampa VA Research Center, she focused on improving the lives of Veterans with disabilities to enable them to become active and healthy. Dr. Powell-Cope speaks and lectures extensively on the topic and was one of Mobility is Medicine's first workshop presenters in 2019.
The video series focuses on mobilizing patients early and the benefits of proning from three different disciplines lending to a holistic approach, which is more likely to result in sustained success. Proning is not just about “flipping the patient over.” An important piece of the proning puzzle reveals the four dimensions of mobility culture to keep workers (as well as patients) safe while placing patients in the prone position:
- People (workers, patients, and stakeholders)
- Belief systems (outdated systems related to mobility and evidence pointing to why we need to view mobility from an interdisciplinary approach)
- Mobility technology (why we need devices to move patients to the prone position, including friction-reducing sheets and ceiling lifts)
- Leadership (how everyone in your organization, not just C-Suite, can provide leadership related to mobility)
Beware of HAPI Risk When Proning
Atlas and MiM are passionate about educating and advocating for mobility and its benefits. In addition to proning, there are other considerations that are highlighted in the video series. For example, preventive skin care, (including the proper patient support, surfaces, ointments, and prophylactic dressings) are essential and must be addressed prior to proning. Additionally, healthcare professionals should keep an eye out for signs of Hospital Acquired Pressure Injuries (HAPI) as they begin to appear as early as 48 hours in a well-padded area of the body. Furthermore, deep tissue pressure injuries can lead to necrotic tissue even in cases when the patient has a good turning schedule and proper nutrition, which means prevention of skin injuries should always be a high priority!
Proning Can Save Lives
Even though the number of COVID-19 cases and deaths continue to rise, there are still many skeptics. However, Atlas is no stranger to real-life stories and the impact it has had on many lives. In fact, it has been very real for Andrew Kegle, one of Atlas’ Program Managers at a Northern California Hospital. Upon managing patients and staff during the COVID-19 pandemic, Andrew vividly recalls, “When we first had “the scare” in early 2020, many hospital staff did not want to work with infected patients. However, Atlas Mobility Coaches continuously step-up and assist clinical staff with moving and proning these patients.” Andrew continued to reflect on the past year with one particular success story about a gentleman in his 30’s who came into the facility. He tested positive and was immediately brought into the ICU. Within 12 hours of being admitted, he was intubated and ventilated. During the course of his hospital stay, the Mobility Coach Program assisted with Q2 turns, boosts and repositioning, proning and getting the patient up into an Arjo Sara Combilizer cardiac chair. After three negative tests, he was downgraded and pushed over to the telemetry unit. He worked with physical therapy to get his mobility back and released to go home with his family. Andrew states, “I believe that Atlas truly makes a difference in other people’s lives. The Safe Patient Handling Programand techniques demonstrated give clinical staff the confidence to get people up and out of bed. After 46 days in the ICU and on the verge of dying, he had a turning point. This gentleman is alive today!”
Look for Partners
Having an extra set of hands to support the proning process can literally be life changing. Look for a proven partner who can be an addition to your turn and position staffing while providing bedside coaching support. Additionally, they should bring a high level of understanding with equipment expertise and adhere to protocol while keeping the staff safe.
COVID-19 has impacted ICU care providers as much as patients and Atlas Lift Tech is committed to helping essential workers who care for the critically ill. To learn how Atlas and your ICU team can prone, safely-sustain turning protocols and prevent pressure injury, please click here: Atlas Lift Tech Assessment for a quick, 60-second assessment tool that can immediately assist with an extra set of hands and in-bed mobility expertise. An Atlas professional will follow up with you to see how we can help.