In December 2020, IHI’s annual conference transitioned their Scientific Symposium to a virtual platform to address longstanding issues in healthcare and celebrate​ improvements across the continuum of care. In addition to educational programs and leadership presentations, the Scientific Symposium included “poster presentations” authored by organizations who have applied scientific methods to healthcare improvement. IHI accepted Atlas Lift Tech’s peer-reviewed poster written by Karen K. Giuliano, in collaboration with NorthBay Healthcare (Fairfield, CA), to spotlight Atlas’ success with improving staff and safe patient handling with the implementation of a protocol for prone positioning using ceiling lifts and Atlas Mobility Coaches.

‍The Institute for Healthcare Improvement (IHI) is a 25+ year old organization that uses a unique approach known as “improvement science” to advance and sustain better outcomes in healthcare systems, health of individuals and other organizations across the world. They bring awareness of safety and quality, systematic improvement of care, develop solutions to challenges, and mobilize health systems and communities to reduce harm and deaths. In the course of the COVID-19 pandemic, it became increasingly clear that the healthcare field desperately needed evidence to be produced, evaluated, and applied more rapidly than ever.

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Background

Prone positioning is an important therapeutic option for improving oxygenation in patients with ARDS which has recently become a more widespread intervention with COVID-19 induced ARDS. Nurses can sometimes be reluctant to initiate prone positioning because of the clinical complexity and potential safety risks of the maneuver

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Objectives

To develop and implement an evidence-based prone positioning protocol in collaboration with Mobility Coaches who provide prone positioning assistance and safe patient handling and mobility expertise.

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Methods

• An evidence-based protocol was developed in 2016 using published evidence, safe patient handling and mobility (SPHM) standards, and information presented at AACN’s National Teaching Institute.
• A small work group of ICU nurses adapted a proning protocol to meet the needs of ICU patients in both a large and small ICU setting.
• The protocol required 9 staff members: the primary ICU Nurse, 1-2 respiratory care practitioners, 1-2 Mobility Coaches and 4-6 ICU or acute care RNs. Certified nursing assistants could supplement the team in the smaller ICU to provide enough staff.

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In 2020, the protocol was revised to incorporate ceiling lifts. This changed patient weight limitations, reduced the number of required staff required and expanded the Mobility Coach role.

• Mobility Coaches helped to ensure the use of all appropriate SPHM equipment, including a friction reducing sheet to avoid the need for lifting.

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Evaluation and Outcomes

• The consistency, safety, and ongoing data collection related to our protocol has removed staff fears.
• Collaboration with the Mobility Coaches has helped to achieve zero staff injuries, a high level of competence and the confidence of staff to use prone positioning as needed.
• The use of pillow support has eliminated the facial pressure injuries we initially experienced with the face cradle.
• We will continue to monitor for any prone-positioning related facial pressure injuries and revise our head support strategy as needed.

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Covid-19 demonstrated the value in patient proning. Atlas Mobility Coaches work side-by-side with healthcare staff to ease the burden of constant lifts and turns. They are expertly trained in Safe Patient Handling and Mobility, they coach staff and assist with proning, turning, repositioning, boosting and transporting activities – at the patient bedside and throughout the hospital. Essentially, they are the extra set of hands your nurses need to get an effective mobility program off the ground! Our Coaches are inspired by and worked with Kathleen Vollman MSN, RN, CCNS, FCCM, FAAN to compile educational content specific to mobility and proning. Kathleen was one of the authors of the AACN Proning Procedure Manual. She is joined by Dr. Joyce Black PhD, RN, FAAN and Dr. Gail Powell-Cope PhD, APRN, FAAN in the Proning Safely Series presented by Mobility is Medicine (Supported by Atlas Lift Tech).

Atlas’ success at NorthBay Healthcare is just one example of the many locations that have implemented programs at hospitals across the country.  From the West Coast at a facility in California to the East at a facility in Georgia – The Atlas Proning Program reduces pressure on front-line staff who are the best asset in the fight against Covid-19 and for the days beyond the pandemic. That is why it is vital to keep them focused on the most important aspects of care.

As Covid-19 cases surged in early 2021, a Georgia facility entered into a state of “diversion” – the hospital was at full capacity and there was no space for incoming patients. The staff was expecting to see the surge during the last week of January and heading into the month of February, so they proactively began asking non-clinical employees (e.g., Administration, Marketing, Human Resources) on a voluntary basis to get trained on how to prone and turn patients, use friction-reducing devices and using ceiling lifts. The facility allowed a “crash course” to become a CNA and gave an option to “choose” their duty and decided if they were ready to be a part of a turn team.

Atlas Program Manager, Laura-Lee Ivey, recalls a recent proning success story with the use of a ceiling lift with a 543 lb. male patient who was unconscious in the ER. He had started in the ICU, but with the assistance of Mobility Coaches who worked with him and assisted his nurses, they moved him into intermediate care (a step-down from ICU) where the Mobility Coaches assisted with lateral transfers, wound care and used a ceiling lift. The patient moved again to the next step-down unit (med-surge unit) where Mobility Coaches were called upon for a recommendation.  They advised that the patient should be admitted into a room with a ceiling lift and continue with his therapy.  Laura-Lee reflects, “The facility staff is always appreciative of the Mobility Coaches’ expertise and amazed with the efficiency of a ceiling lift which replaces ten people!” With the excellent attention given by the Atlas Mobility Coaches, the patient was released after 2 weeks.

As we head out West, Alton Smith, Atlas Program Manager, is managing the “Covid-19 Assistance Program”. Alton Smith, Atlas Program Manager, is managing the “Covid-19 Assistance Program”.  This program has two dedicated Mobility Coaches focusing on three-to-four Covid-19 patients during the hours of 12:00 p.m. – 10:30 p.m. Stationed in the ICU/CVICU and focusing on patients who were not mobile, the Mobility Coaches were able to provide more 1x1 attention and assisted with boosts, repositioning and proning with the use of sheets, sliders and comfort gliders. As a result, the nursing staff morale exponentially improved and they were infinitely grateful for the focused attention that the Mobility Coaches were able to provide.

Your journey towards the successful deployment of a mobility program and a proning program begins with a facility assessment. This includes an in-depth review of current practices on the floor, equipment inventory and usage, annual incurred cost of patient handling injuries, as well as peripheral elements of the program. We work with your team to identify potential barriers to success and develop a plan of action to overcome them. We provide mobility solutions that help you create a supportive, sustainable process and infrastructure for care providers, giving them the confidence to perform SPHM tasks safely and effectively.

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References

1. Dirkes SM, Kozlowski C. Early Mobility in the Intensive Care Unit: Evidence, Barriers, and Future Directions. Crit Care Nurse. 2019; 39 (3): 33–42.  See link to abstract: https://doi.org/10.4037/ccn2019654