Using In Situ Simulation to Develop a Prone Positioning Protocol for Patients With ARDS

Critical Care Nurse
Jessica Montanaro

Abstract

Acute respiratory distress syndrome carries a 40% mortality rate. Prone positioning remains underused owing to clinicians' low degree of confidence, concern about the risk of adverse outcomes, and lack of staff competency training. A prone positioning protocol and educational program were needed in an intensive care unit to achieve compliance with best practices for treating acute respiratory distress syndrome patients. An initial survey was conducted to measure staff confidence and competency in prone positioning. A literature review was performed, and a plan-do-study-act approach was used to develop a protocol through in situ simulation involving mock patients. A training video and a simulation scenario using a high-fidelity manikin were developed to facilitate staff education. Staff were surveyed again after training. During the simulation scenario, interdisciplinary clinicians learned to apply the protocol and resupinate the patient during a simulated emergency. The training video was later used for "just in time" education minutes before actual prone positioning events. A total of 25 critical care nurses, 11 respiratory therapists, and 10 physicians completed the initial survey and simulation training. The survey showed th...Continue Reading

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