J Healthc Qual. 2021;43(4):195-203. doi: 10.1097/JHQ.0000000000000305.
The COVID-19 pandemic has caused over 1,250,000 deaths worldwide. With limited therapeutic options, proning nonintubated patients emerged as a safe and affordable intervention to manage hypoxemia.
A proning protocol to identify and prone eligible patients was implemented. Patients were encouraged to self-prone for 2-3 hours, 3 times daily. Investigators created educational materials for nurses and patients and developed a COVID-19-specific proning order within the electronic health record (EHR). Investigators completed an 800-person retrospective chart review to study the implementation of this protocol.
From March 22, 2020, to June 5, 2020, 586 patients were admitted to the COVID-19 floor. Of these patients, 42.8% were eligible for proning. Common contraindications were lack of hypoxia, altered mental status, and fall risk. The proning protocol led to a significant improvement in provider awareness of patients appropriate for proning, increasing from 12% to 83%, as measured by placement of a proning order into the EHR. There was a significant improvement in all appropriate patients documented as proned, increasing from 18% to 45% of eligible patients.
The creation of an effective hospital-wide proning protocol to address the exigencies of the COVID-19 pandemic is possible and may be accomplished in a short period of time.
COVID-19 大流行已在全球范围内导致超过 125 万人死亡。由于治疗选择有限，对非插管患者进行俯卧位通气成为一种安全且经济实惠的方法，可用于治疗低氧血症。
实施了俯卧位通气方案以识别和俯卧位通气符合条件的患者。鼓励患者每天自行俯卧位 2-3 小时，3 次/天。研究人员为护士和患者创建了教育材料，并在电子健康记录（EHR）中制定了 COVID-19 专用的俯卧位通气医嘱。研究人员完成了一项 800 例回顾性图表审查，以研究该方案的实施情况。
从 2020 年 3 月 22 日至 2020 年 6 月 5 日，586 名患者入住 COVID-19 病房。其中，42.8%的患者适合俯卧位通气。常见的禁忌症包括缺氧、意识状态改变和跌倒风险。俯卧位通气方案显著提高了医护人员对适合俯卧位通气患者的认识，通过在 EHR 中下达俯卧位通气医嘱，这一比例从 12%提高到 83%。所有适合俯卧位通气的患者都进行了记录，符合条件的患者中，进行俯卧位通气的比例从 18%提高到 45%。
创建有效的全院俯卧位通气方案来应对 COVID-19 大流行的紧急情况是可行的，并且可以在短时间内完成。
