Proning COVID-19 patients: Reducing facial tissue injuries

Purpose: COVID-19 patients in our Medical Intensive Care Unit (MICU) developed acute respiratory distress syndrome (ARDS). Prone therapy (PT) was utilized and many developed significant facial tissue injuries. An evidence based (EB), innovative nursing approach was developed to decrease facial tissue injury. Relevance/Significance: Despite benefits of implementing PT to improve patient oxygenation, facial tissue injury related to positional edema was a significant concern. After application of current EB recommendations to minimize skin damage in proned patients, the incidence of facial tissue injury remained significant. In a multidisciplinary collaboration, a new, prophylactic technique was developed in placing a foam dressing directly to the cheeks, under the endotracheal tube (ETT) tape, prior to starting PT. Implementation Strategies: Application of a prophylactic foam dressing directly on the cheeks, underneath the ETT securement tape, was created. A decrease in facial injuries was found and a quality-improvement project was developed to examine the incidence of injuries in patients with PT prior to, and after, application of the preventative foam dressing. IRB approval was obtained and utilized a convenience sample resulting in a total of 46 patients identified who received PT between 04/01/2020 and 05/31/2020. The sample was split into two cohorts; 22 who received standard preventative measures and 24 who received the intervention. Patient demographics, number of days proned and facial injury rates were collected. Evaluate the Impact/Effectiveness:Utilizing a chronological convenience sample without randomization, the pre-intervention cohort (n=22) demonstrated a significantly higher number of facial skin injuries compared to the cohort (n=24) receiving the intervention (p Implications for Nursing Practice: Application of a prophylactic foam dressing under the ETT securement tape can significantly impact development of facial tissue injuries for patients receiving prone therapy. Further study of this nurse-driven intervention is needed to extrapolate the findings