Reducing Pressure Injury: An Effective Approach to Manual Prone Positioning in the Intensive Care Unit (ICU)

Background:The evolution of proning patients in the ICU over the last forty years has not decreased the risk of pressure injuries. ICU patients are at a higher risk for pressure injury due to their pre-existing conditions and severity of illness. The purpose of this study was to describe the use of a static air overlay mattress (SAOM) to manually prone patients in an adult medical intensive care unit (MICU).  Objectives include: 1) describe occurrence of hospital acquired pressure injury (HAPI) with the SAOM compared to commercial methods (CM) 2) evaluate the feasibility of the SAOM method for manually proning patients from the nurse perspective. 

Method/Results:This mixed methods study examined 29 adult patients who were proned in MICU during 2014-2016. Using the SAOM method there were 21 patients, as compared to 8 using CM proning. Pressure injury occurrence was identified thru documentation from certified wound, ostomy, and continence nurses. Of those patients proned with the SAOM method, N=2 (9.5%) developed a HAPI compared to N=3 (37.5%) in the CM group. The primary admission diagnosis was acute respiratory failure in both groups (SAOM n=19, 90%; CM n=7, 87.5%). Of the risk factors examined, SAOM patients were hemodynamically more stable than CM (p=0.04, x² (1) =3.04). Bowel management devices in the SAOM were n=19 (90%) and n=3 (37%) in the CM (p=.004, x² (3) =13.08). A feasibility survey was analyzed with 24 responses reporting high confidence with the SAOM method. Common themes identified from the focus groups were safety, ability to implement sooner, and the lack of having to wait on delivery of a specialty product. 

Conclusions:This study suggests the SAOM method is easy to use, readily accessible, and is a safe method in adult MICU patients. The SAOM method reduced HAPI development during this acute period in prone position.