Date of Award

Summer 2022

Document Type

Final DNP Paper

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

Faculty Chair

Douglas Stephens

Abstract

Background: Acute Respiratory Distress Syndrome (ARDS) is an acute pulmonary process that compromises the health of patients in the Intensive Care Unit (ICU). ARDS can progress to irreversible fibrosis causing the lungs to become noncompliant, adversely affecting ventilation or gas exchange (Buckley et al., 2019). An ARDS diagnosis accounts for 30-40% mortality rate which is an improvement from 60% in the last two decades. The clinical course of this disease is highlighted by Acute Hypoxic Respiratory Failure (AHRF) evidenced by chest radiographs revealing bilateral dense consolidations. Manual pronation of ARDS patients has shown an increase in alveolar function with end expiratory lung volume, which leads to improvement in oxygenation and rate of survival.

Purpose: The purpose of the DNP project was to implement a proning protocol to increase pronation among all ARDS patients located in the Medical Intensive Care Unit (MICU) and Cardiac Care Unit (CCU). This protocol highlights the criteria for ARDs and systematic pronation process.

Methods: The quality improvement project implemented a multi-model approach to advocate for pronation. A Standard Operating Procedure (SOP) was adopted from existing medical facilities and approved through both the Critical Care Steering Committee and Clinical Practice Council. The protocol incorporated a checklist to assist healthcare staff for the pronation process. Pronation training sessions were conducted with 45 healthcare staff in two ICUs: MICU and CCU. The training was a multi-modal approach. First sessions were incorporated to re-introduce the staff to the SOP highlighting the criteria for ARDS and the process of pronation, along with introducing the checklist and the pronation kits. Second sessions were the formative simulation experiences, which provided hands-on learning for the staff. The simulation experiences included an ARDS case scenario, concluded by a debriefing session to process on the event and reflect on the impact. The pronation process was initiated following the training opportunities and was tracked. The pronation checklist assisted in the activation of pronation among ARDS patients.

Results: Key results of the study concluded an increase in the number of patients pronated. Prior to the pronation intervention implementation, only 45% of ARDS patients located in MICU and CCU were mechanically proned. Fifty-five percent of patients were treated in a supinated position despite meeting pronation criteria. Once the pronation protocol was implemented, 100% of ventilated ARDS patients meeting pronation criteria were proned.

Conclusion: With the adoption of a protocol and process, pronation increased with MICU and CCU for all patient diagnosed with ARDS.

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