During the COVID-19 pandemic, prone positioning of patients with or without mechanical ventilation was widely adopted at healthcare organizations worldwide. While proning improves blood oxygenation and survival rates for patients in respiratory distress, it’s a challenging procedure that requires a team of nurses, physicians, respiratory therapists and patient care nurse assistants (PCNAs). One of the concerns is ensuring the right supplies are at hand during the position change.
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The team of caregivers in Cleveland Clinic Fairview Hospital’s medical and surgical intensive care units (MICU and SICU) initially stored supplies in large plastic bins. But as the number of patients requiring prone positioning increased, the bins proved ineffective.
The bins took up too much space and made it difficult to manage the supplies, says Chris Moore, a PCNA in the MICU and SICU. Sometimes the lids were hastily removed and ended up on the floor, where they could be stepped on and broken. In addition, if supplies were brought into the room and the patient did not end up being moved into the prone position, the supplies were wasted through contamination, and it took time to fill another bin.
A new way to manage proning supplies
“I decided we needed a better way to manage our proning supplies,” says Moore. In the spring of 2020, he began researching options online, but couldn’t find a ready-made prone positioning kit. So he created one.
“I talked to the nurses about what they needed and put together a grab-and-go kit,” he says. With the support of his nurse manager, Moore ordered large, tamper-proof bags to secure supplies, such as sutures, gauze bandages, IV line extensions, feeding tubes and foam wound dressings. He placed all the supplies in the bags, along with a pillow that can be molded around the patient’s face to prevent skin breakdown and pressure injuries.
The proning kits are a hit with nurses. “They take them off the shelf and have everything they need, so they don’t have to look around for any supplies,” says Moore. “Once you break the seal on the bag, there’s no way to close it again. The bag is ruined, so nurses can tell if something has been taken out.” The bagged kits also require less storage space.
“The individualized pronation kits helped save both time and money during a very challenging time,” says Lorri Martin, BSN, CCRN, Nurse Manager of the MICU. “They also help us keep appropriate par levels.”
With encouragement from Martin, Moore submitted his prone positioning kit to Cleveland Clinic’s annual Nursing Innovation Inventory and earned second place.