Increasing Rates of Prone Positioning in Acute Care Patients With COVID-19
| Autor: | Jolie Berke, Leora I. Horwitz, Jonah Zaretsky, Elizabeth Savage, Greg Sweeney, Patricia Laverty, John R. Corcoran, Mary Fischer, Diana Kmita, Jodi Herbsman |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Adult
medicine.medical_specialty Quality management Leadership and Management business.industry Psychological intervention COVID-19 Run chart Respiration Artificial Patient Positioning Prone position Improvement Brief Respiratory failure Oxygen Saturation Acute care Emergency medicine mental disorders medicine Prone Position Humans business Oxygen saturation (medicine) Patient education Retrospective Studies |
| Zdroj: | Joint Commission Journal on Quality and Patient Safety |
| ISSN: | 1938-131X 1553-7250 |
| Popis: | Background Prone positioning improves mortality in patients intubated with acute respiratory distress syndrome and has been proposed as a treatment for non-intubated patients with COVID-19 outside the ICU. However, there are substantial patient and operational barriers to prone positioning on acute floors. Our objective was to increase the frequency of prone positioning among acute care patients with COVID-19. Methods We conducted a retrospective analysis of all adult patients admitted to the acute care floors with COVID-19 respiratory failure. We used a run chart to quantify the frequency of prone positioning over time. For the subset of patients assisted by a dedicated physical therapy team, we compared oxygen before and after positioning. Our initiative consisted of four separate interventions: (1) nursing, physical therapy, physician, and patient education; (2) optimization of supply management and operations; (3) an acute care prone positioning team; and (4) electronic health record optimization. Results From March 9, 2020 to August 26, 2020, 176/875 (20.1%) patients were placed in prone position. Among these, 43 (24.4%) were placed in prone position by the physical therapy team. Only 2/94 (2%) eligible patients admitted in the first two weeks of the pandemic were ever documented in prone position. After launching our initiative, weekly frequency peaked at 13/28 (46.4%). Mean oxygen saturation was 91% prior to prone positioning versus 95.2% after (p < 0.001) in those positioned by physical therapy. Conclusion A multidisciplinary quality improvement initiative increased frequency of prone positioning by proactively addressing barriers in knowledge, equipment, training, and information technology. |
| Databáze: | OpenAIRE |
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