Optimizing nursing workload in the intensive care unit during the COVID-19 pandemic: Planning prone positioning.

BACKGROUND

Prone positioning is a complex, time-consuming task, involving significant intensive care unit staff. The increased workload during the COVID-19 pandemic and the reduced staffing boosted the burden of intensive care unit nurses, which might have a negative impact on patients' safety and outcomes.

METHODS

Retrospective chart review, analysing the hourly distribution of pronation and supination procedures in mechanically ventilated critically ill patients during the first and the second wave of the COVID-19 pandemic (March 2020-May 2021).

RESULTS

303 procedures were analysed: 77 pronation manoeuvres out of 156 (49.3%) and 82 supination out of 147 (55.8%) were performed in dedicated time slots in the afternoon (15.30-19.00) and in the morning (9.30-12.30) shifts, when the nursing staff was increased. At least five healthcare providers performed pronation manoeuvres. Six device displacements were registered.

CONCLUSIONS

Planning complex activities such as prone positioning needs an effective strategy to optimize nursing staff workload in the intensive care unit. This organization allowed to perform pronation cycles with a duration of at least 16 h, according to current clinical recommendations.