October 17, 2022
2 min read
Source/Disclosures
Barrios F, et al. Original investigations: Implementing a nurse-driven protocol for supine trials in patients with ARDS. Presented at: CHEST Annual Meeting; Oct. 16-19, 2022 Nashville, Tennessee.
Disclosures:
Barrios and colleagues report no relevant financial disclosures.
NASHVILLE, Tenn. — A collaboratively designed nurse-driven supine trial protocol for prone, intubated patients with acute respiratory distress syndrome may improve care plan clarity, facilitate planning and reduce stress in ICU nurses.
Researchers presented results of a survey among ICU nurses that showed the benefits of this multidisciplinary protocol at CHEST Annual Meeting.
“The COVID surge was a stressful period in our ICU, and the fear of the unknown caused significant stress to everyone in the ICU. Many patients were being intubated and we knew from previous trials the benefits of proning that we eventually needed to ‘flip’ the patient back to the supine position to help with tasks like skin checks and oral care, but we did not have a process in place that alerted the nurses as to which patients were ‘safe’ enough to flip to the supine position,” Francisco Barrios, MD, resident physician at Dell Medical School at The University of Texas, Austin, told Healio. “The COVID delta wave was quickly overwhelming our ICU. We wanted to create a supine trial protocol based on the insights of a multidisciplinary team of nurses, respiratory therapists and physicians in these emergent circumstances and use surveys to evaluate the impact of these protocols.”
A multidisciplinary team of critical care physicians, nurses and respiratory therapists created a nurse-driven protocol for supine trials for patients with ARDS who were prone and intubated in the ICU.
Researchers designed an anonymous surgery that was distributed via email and social media to gauge nurses’ awareness of which patients would be turned supine that day, difficulty level for day planning and stress level in relation to turning supine prone patients with ARDS.
A total of 82 ICU nurses received the surveys, 51% of whom completed the survey prior to implementing the protocol and 40% who completed it 1-month post-implementation.
When comparing ratings prior to vs. following implementation of this nurse-driven protocol, researchers observed a decrease in the proportion of nurses who said they “almost never” knew at the start of their shift whether prone and intubated patients with ARDS would be turned supine (55% vs. 18%), who rated the difficulty level of planning daily workload with a prone and intubated patient with ARDS as “most difficult” (52% vs. 27%), and who rated stress levels related to turning prone and intubated patients with ARDS as “most stressful” (67% vs. 36%).
According to Barrios, it is important to listen to ICU workers to find where difficult areas are in patient care. This knowledge can lead to opportunities to work with different team members in developing potential solutions to such problems.
“We are no longer seeing massive cases of patients with ARDS requiring intubation and proning, so no further analyses are underway. Our protocols are still laminated and posted outside patients’ rooms whenever cases do present,” Barrios said. “If we do see another surge of patients with ARDS, it will be important to review the protocol and see where are the touchpoints that we can modify to further help guide nurses during these difficult situations.”
Reference:
Barrios F, et al. Chest. 2022;doi:10.1016/j.chest.2022.08.1242.
