Use of a Prone Kit for Prevention of Pressure Ulcers: Does It Impact Outcomes?

     “Prone positioning of critically ill patients with acute respiratory distress syndrome is associated with an increased likelihood of pressure ulcer development.” Hospital acquired pressure ulcers are a never event and significantly impact patient quality of life and facility reimbursement.  In the prone patient, hospital acquired pressure ulcer incidence rates as high as 65% have been reported.

     To help maximize oxygenation, the patient is positioned prone until returned to the supine position.  The length of time a patient is prone varies based on their response to the procedure and the physician’s order.  Because of the difficulty of proning these patients and the need for multiple staff to assist, patients are frequently left prone for up to 12 hours and are at increased risk for developing multiple site pressure ulcers.

     Our facility developed a prone bundle and standardized the process to offload pressure, decrease friction and shear, and provide moisture management for the prone patient. The eight patients who were cared for using the prone bundle did not develop any pressure ulcers, whereas those who were cared for without the use of the prone bundle developed one or more pressure ulcers on their prone surface.

     Use of a pre-assembled prone bundle makes it easy for the nurse to do the right thing and benefits the patient. “Care bundles aim to improve standard of care and patient outcome by promoting the consistent implementation of a group of effective interventions.” Because of the complexity of the variety of products needed to appropriately prevent patient injury, placing them in a kit which is readily available decreases process variation and ensures that adoption of the practice is likely to occur.