Proning Team Became Key Part of Massachusetts General’s COVID-19 Care

A designated proning team became a key part of the COVID-19 care provided by Massachusetts General Hospital, Boston, responding around-the-clock to patients who needed turning and allowing critical care clinicians to focus on other aspects of care.

The innovative proning program was designed to integrate seamlessly into the hospital’s six existing intensive care units (ICUs), as well as five ICUs created to accommodate the surge in patients with severe COVID-19. During the peak of the pandemic, the institution grew its ICU capacity from 109 to 235 beds.

“Development of a Prone Team and Exploration of Staff Perceptions During COVID-19” details how the large academic medical center developed and implemented a proning program during the pandemic. The article is published in AACN Advanced Critical Care.

Co-author and proning team lead Karen Miguel, MM-H, RN, CPPS, is staff specialist, patient care services quality, safety and practice, at Massachusetts General Hospital.

“During the initial surge of patients with severe COVID-19, our trained and dedicated proning team ensured the safety of patients and staff with an efficient and standardized process for managing proning,” she said. “We hope that our work provides a framework for institutions considering creating a proning team, by highlighting the importance of balancing the needs of patients with the overall psychosocial health of the staff caring for them.”

The proning team was available 24 hours a day, seven days a week. It had two teams of four during the day and evening shifts, with a team of four on the night shift. Each interdisciplinary team consisted of at least one operating room (OR) nurse and one physical therapist.

About 70 OR nurses, OR assistants and outpatient physical therapists from the hospital’s labor pool were chosen for the program, due to their knowledge of prone positioning and strong understanding of safe mobilization and positioning.

Team members were trained using a hybrid learning model focused on prone-positioning techniques, pressure injury prevention and turning-related adverse events. The training included a refresher on proper technique for donning and doffing personal protective equipment. A 60-minute simulation allowed them to practice the basic safety steps and work through various scenarios.

During its eight weeks of operation, the proning team successfully turned 147 patients 450 times, with no adverse effects for the patients or physical harm to the team members. The size of the team was adjusted when turn demand decreased.

A resource nurse served as liaison between the ICUs and the proning team, streamlining patient preparation and response. Supporting tools included daily report sheets for rounding to all ICUs, real-time reports from the electronic medical record, and an enhanced checklist for preproning, proning and postproning needs.

A wound care specialist reviewed reports related to pressure injury development, which led to several pressure-relieving products being added to the existing formulary. In addition, a new procedure for taping endotracheal tubes was implemented as part of the process to preprone patients.

To prepare for possible mobilization of the proning program in the event of a future surge, the hospital also surveyed proning team members and the ICU staff about their experience.

Proning team members overwhelmingly reported a positive experience during the program and that they felt prepared for the role. They also offered suggestions to help future proning teams. Of the 72 team members, 54 responded to the survey.

More than 200 responses from ICU clinicians were received from the 11 ICUs. More than 90% agreed or strongly agreed that the proning team was an asset in the ICU. The majority of ordering providers were more likely to order prone positioning knowing that a trained team was available. 

The article is one of several published in the journal’s summer 2021 issue about understanding the impact of COVID-19, now and for the future. Other articles in the symposia focus on:

• Care for patients with post-COVID-19 syndrome
• Strategies to address clinician burnout and promote well-being and resilience
• The impact of COVID-19 on the patients’ cardiovascular system

AACN Advanced Critical Care is a quarterly, peer-reviewed publication with in-depth articles intended for experienced critical care and acute care clinicians at the bedside, advanced practice nurses, and clinical and academic educators. Each issue includes a topic-based symposium, feature articles and columns of interest to critical and progressive care clinicians.

Access the issue by visiting the AACN Advanced Critical Care website at http://acc.aacnjournals.org/.

About AACN Advanced Critical Care: AACN Advanced Critical Care is a quarterly, peer-reviewed publication with in-depth articles intended for experienced critical care and acute care clinicians at the bedside, advanced practice nurses, and clinical and academic educators. An official publication of the American Association of Critical-Care Nurses (AACN), the journal has a circulation of 4,845 and can be accessed at http://acc.aacnjournals.org/.

About the American Association of Critical-Care Nurses: For more than 50 years, the American Association of Critical-Care Nurses (AACN) has been dedicated to acute and critical care nursing excellence. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. AACN is the world’s largest specialty nursing organization, with more than 130,000 members and over 200 chapters in the United States.

American Association of Critical-Care Nurses, 27071 Aliso Creek Road, Aliso Viejo, CA 92656; 949-362-2000; www.aacn.org; facebook.com/aacnface; twitter.com/aacnme