The Art of Proning

Published in Howard County General Hospital Nursing Annual Report - 2019-2020

The ICU in most hospitals was ground zero early in the pandemic. Howard County General Hospital’s ICU was no different. Processes and protocols for caring for patients with COVID-19 were changing and evolving constantly.

ICU Clinical Coordinator Ash Caretti, RN, CCRN, explains how the ICU flexed early in the pandemic, as volumes increased and staff learned along the way.

“Early research and new studies were being published that provided guidance in the treatment of patients with COVID-19. Proning, which is when the patient is placed on their stomach, is a normal standard of care in patients with acute respiratory distress syndrome (ARDS), and the research showed this to be an effective tool with patients with COVID-19. The purpose of proning is to allow better distribution and volume of air in the lungs. When the patient is proned, the position facilitates better ventilation of the posterior lung regions. HCGH had a manual process, but with the number of patients we were proning, it required a team. We gathered a multidisciplinary team which included physical therapy, occupational therapy, respiratory therapy and nursing to figure out the best way to do it.

“We have tried multiple ways to prone patients. We have used specialty prone pillows and specialty prone beds to help with the process. In our process of proning, the patient is on a flat sheet, we place padding on bony areas and position pillows to protect their chest, pelvis, knees and feet. We typically use three team members on either side of the patient and respiratory at the head of the bed to manage the patient’s airway. We then gently and strategically roll them from their back to side and then prone on the stomach. These patients typically stay proned for 16 hours. We have worked hard in mastering the process and it has been very impactful in treating our patients.

“As a nurse, you are constantly learning, and the pandemic has definitely inspired me to continue to increase my knowledge.”

A Letter from Jennifer Baldwin, CNO/VP of Nursing

"In a year unlike any other, the nurses at Howard County General Hospital have continued to show their unwavering dedication in caring for our patients..."

HCGH at night