IMPLEMENTING A NURSE-DRIVEN PROTOCOL FOR SUPINE TRIALS IN PATIENTS WITH ARDS

ABSTRACT

SESSION TITLE Quality Improvement SESSION TYPE Original Investigations PRESENTED ON 10/17/22 130 pm - 230 pm PURPOSE: Prone positioning has been shown to improve survival in patients with Acute Respiratory Distress Syndrome (ARDS). Moving patients from prone to supine position and vice versa adds significant labor for nursing staff, who are already under great stress during the COVID 19 pandemic. We designed a nurse-driven protocol that enables nurses to identify prone intubated ARDS patients who meet criteria to be turned supine and independently implement the change in position. In order to evaluate whether this protocol reduces stress, we surveyed nurses before and after implementation. METHODS: A multidisciplinary team of critical care physicians, nurses, and respiratory therapists designed a nurse-driven protocol for supine trials for prone intubated ARDS patients in a medical intensive care unit (MICU). We designed an anonymous survey to gauge nurses’ awareness of which patients would be turned supine that day, level of difficulty planning their day, and stress level related to supining of a prone ARDS patient. We sent the survey to the nursing staff before implementing the protocol, and again one month after implementation. The survey was sent by professional email and via a private group on social media. Halfway between the surveys, a PDSA cycle was used to modify the protocol with the feedback from nurses and respiratory therapists. RESULTS: Of 82 MICU nurses who received the surveys, 42 (51%) responded to the pre-implementation survey and 33 (40%) responded to the post-implementation survey. Nurses were asked to rate how often they knew at the beginning of their shift whether their prone intubated ARDS patient would be turned supine that day on a 5 point Likert scale (5 indicating “almost never”). Nurses who rated 4 or 5 decreased from 55% (23) pre-implementation to 18% (6) post-implementation. Nurses were asked to rate the difficulty of planning their daily work with a prone intubated ARDS patient on a 5-point Likert scale (5 indicating “most difficult”). Nurses who rated 4 or 5 decreased from 52% (22) to 27% (9) post-implementation. Nurses were asked to rate stress associated with “flipping” their prone intubated ARDS patient on a 5-point Likert scale (5 indicating “most stressful”). Nurses who rated a 4 or 5 decreased from 67% (28) to 36% (12) post-implementation. CONCLUSIONS: A collaboratively developed nurse-driven protocol for supine trials in the prone intubated ARDS patient can improve clarity of the plan of care, facilitate planning the day’s work, and reduce stress amongst Medical ICU nurses who manage these patients. CLINICAL IMPLICATIONS Institutions can assemble a multidisciplinary team to create a nurse-driven protocol for supine trials to potentially empower nurses in the care of their patients with ARDS. DISCLOSURES No relevant relationships by Daniel Ahle No relevant relationships by Francisco Barrios no disclosure on file for Jaclyn Boozalis;No relevant relationships by Paul Harford No relevant relationships by Shailaja Hayden no disclosure on file for Jessica Ybarra;