Teresa McKenney, BA, RN, CWCN
In the early weeks of COVID-19—before fully understanding the illness’s complexities and nuance—prone positioning became a clear treatment preference among ICU and COVID unit caregiver teams. But doing it correctly, without risk of injury to the care team or patient, takes consistency and commitment to some key safety measures.
The Benefits of Proning
First, it’s essential to understand why proning is effective. While proned (lying face down), gravity helps clear the patient’s lungs naturally, providing more space for oxygen. Since the lungs of COVID patients are especially at-risk for fatal fluid buildup, proning has proven to be extremely beneficial.1 More than 70% of proned patients experience improved oxygenation within one hour. Over longer periods, proning facilitates drainage of pulmonary secretions, reduces ventilation time, and improves survival rates.2
The benefits of proning patients suffering from COVID are clear and overwhelming. For caregivers, however, the process is complicated. It requires a full team and, if done incorrectly, the patient and nurses are at risk for a variety of injuries and complications.
Protecting the Care Team
Healthcare providers consistently rank among the top occupations with disabling back injuries—often degenerative injuries over months and years of repetitive actions, primarily from manually lifting and boosting patients.3
Limited research on the issue shows a few main challenges to proning patients safely: mainly a lack, or perceived lack, of the right equipment; or insufficient access to the equipment because of multiple units needing to share. The unfortunate result: too many nurses putting themselves at risk for musculoskeletal injury.
A few simple tips can help ensure consistency and reduce risk:
- Educate all staff on correct proning procedures
- Assign a leader each time a patient is proned or returned to supine
- Follow safety, communication, and procedural checklists every time
- Consider each patient’s specific needs to ensure proper staff and resources (ie: heavier patients require more staff)
- Consider lift equipment, turn-assist bed frames, and/or low air loss support surfaces to aid in this higher level of care
During times of crisis like COVID-19, health care teams must find innovative solutions and implement them effectively. Sizewise doesn’t offer prone therapy training, but our Clinical Support team is always available to help you better understand equipment options that could make your job easier.
Khamsi R. ‘Proning’ Covid Patients Seems to Save Lives. But How Many? Wired Magazine. 2020 Nov. 12. Retrieved from: www.wired.com/story/proning-covid-patients-seems-to-save-lives-but-how-many/
Selvi E, C., K V Rao, K., & Malathl, 2013
Dressner M, Kissinger S. Occupational injuries and illnesses among registered nurses. Monthly Labor Review. 2018. U.S. Bureau of Labor Statistics. Retrieved from: www.bls.gov/opub/mlr/2018/article/occupational-injuries-and-illnesses-among-registered-nurses.htm#:~:text=Source%3A%20U.S.%20Bureau%20of%20 Labor,within%20the%20occupation%20in%202016.&text=Nurses%20ages%2045%20to%2054,of%20all%20injuries%20and%20illnesses
Need more info? The Sizewise Clinical Support Team is available to answer your questions or provide additional training. Call 800-814-9389 or email firstname.lastname@example.org.