Authors (including presenting author) :
CHAN WC(1), HO SM(1), NG YB(2), TSO YK(2)
Affiliation :
(1) Ward 13A, Department of Medicine & Geriatrics, United Christian Hospital
(2) Department of Medicine & Geriatrics, United Christian Hospital
Introduction :
The emergence of COVID-19 has overwhelmed the healthcare system with a sudden increase of pneumonic patients. COVID-19 patients may develop respiratory distress or even respiratory failure. Adopting awake prone positioning in non-intubated patients with COVID-19 pneumonia is a low-risk, low-cost strategy that may potentially delay or reduce the need for intensive care. Based on the current evidence and benefits of prone positioning for pneumonia patients, the programme of awake prone positioning for non-intubated oxygen dependent COVID-19 patients in an isolation ward was launched on 1st August, 2020. Indicated patients were guided with awake self proning and patient outcomes were reviewed. This programme is to help non-intubated COVID-19 patients improve respiratory condition by promoting awake self proning.
Objectives :
(1) To facilitate respiration and lung recruitment of non-intubated oxygen dependent COVID-19 patients;
(2) To minimise intubation in COVID-19 patients;
(3) To empower nursing staff to take care of proning patients
Methodology :
The programme of awake prone positioning for COVID-19 patients in isolation underwent three phases. The first phase was literature search, experience sharing and discussion with ward physicians. The second phase was to develop a clinical protocol on awake prone positioning for COVID-19 patients including the selection criteria, indications, contraindications and the related nursing care. The third phase was to monitor patient outcomes and staff compliance. Data was collected throughout the period of the programme, and patient and staff feedback were interviewed for further review and analysis.
Result & Outcome :
Result
From 1st August to 30th November, 2020, 285 COVID-19 patients were treated in United Christian Hospital of whom 56% were male. 8 patients with moderate to severe pneumonia were indicated and recruited for awake prone positioning, 2 of them withdrew from the programme due to unfitness and refusal. 6 patients underwent awake prone positioning as educated by trained isolation ward nurses, the average daily proning hours were 8 - 15 hours. 4 patients discharged, 1 patient was transferred to ICU, and 1 patient succumbed. All discharged patients reported positive feedback in a few areas, such as improving respiratory conditions like dyspnea or chest tightness, the close nursing monitoring and appropriate patient education. All nursing staff completed the training on awake prone positioning protocol and were able to perform prone care with 100% compliance.
Conclusion
Awake prone positioning is a safe and non-invasive measure to improve COVID-19 patient outcomes. Limitations were encountered in caring COVID-19 patients with prone position due to isolation settings and rapid change of patient conditions. Further data reviews and monitoring are needed to improve the programme. In conclusion, with a consolidated programme, it is hoped that both patients and isolation ward nurses would be benefited.
