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The purpose of this quality improvement project is to reduce the incidence of pressure injuries among patients managed with prone positioning for acute respiratory syndrome (ARDS) in the MICU.
Background:
Patients managed with prone positioning for ARDS have an increased risk of developing a pressure injury. Peer reviewed studies report an incidence of pressure injuries related to prone position of up to 49%. Unrelieved pressure for extended periods leads to breakdown. Prolonged prone position, difficulty repositioning, hemodynamic instability and use of norepinephrine, increase risk. Pressure injuries increase costs and LOS. We developed a practice change utilizing a custom device to permit ease of turning patients in prone position and prevent pressure injuries from developing. Between 12/2014 and 1/31/2017, 35 patients treated for ARDS with prone positioning were followed.
Methods:
All patients undergoing prone positioning for ARDS management were placed on a low-pressure air chamber designed to adapt to the patient by positive air displacement, with conformable fluidized positioners under the air chamber. Patients were turned and repositioned every two hours. Data were collected on gender, age, BMI, frequency and duration of prone position, use of norepinephrine, and incidence of breakdown to 72 hours post termination of prone positioning.
Results:
Data were collected on 35 patients from 12/2014-1/2017. Of these, 83.3% were on norepinephrine. The average BMI was 32.7 (17-58). The average time spent in the prone position was 15.8 hours per day for 3.8 days, with maximums of 19.9 hours per day, and 10 days. None of the patients developed pressure injuries during the observation period.
Conclusion:
Use of low-pressure air chamber and fluidized positioners is effective in preventing pressure injuries among patients managed with prone positioning for ARDS. We continue to utilize this device to provide quality of care to this patient population.