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. 2017 Apr-Jun;29(2):131-141.
doi: 10.5935/0103-507X.20170023.

Safe prone checklist: construction and implementation of a tool for performing the prone maneuver

[Article in Portuguese, English]
Vanessa Martins Oliveira  1 , Daniele Martins Piekala  1 , Gracieli Nadalon Deponti  1 , Danusa Cassiana Rigo Batista  1 , Sílvia Daniela Minossi  1 , Marcele Chisté  1 , Patrícia Maurello Neves Bairros  1 , Wagner da Silva Naue  1 , Dulce Inês Welter  1 , Sílvia Regina Rios Vieira  2
Affiliations

Safe prone checklist: construction and implementation of a tool for performing the prone maneuver

[Article in Portuguese, English]
Vanessa Martins Oliveira et al. Rev Bras Ter Intensiva. 2017 Apr-Jun.

Abstract
in English, Portuguese, Portuguese

Objective: To construct and implement an instrument (checklist) to improve safety when performing the prone maneuver.

Methods: This was an applied, qualitative and descriptive study. The instrument was developed based on a broad review of the literature pertaining to the construction of a care protocol using the main electronic databases (MEDLINE, LILACS and Cochrane).

Results: We describe the construction of a patient safety tool with numerous modifications and adaptations based on the observations of the multidisciplinary team regarding its use in daily practice.

Conclusion: The use of the checklist when performing the prone maneuver increased the safety and reliability of the procedure. The team's understanding of the tool's importance to patient safety and training in its use are necessary for its success.

Objetivo: Construir e implementar um instrumento (checklist) para melhoria do cuidado na manobra prona.

Métodos: Estudo aplicativo, qualitativo e descritivo. O instrumento foi desenvolvido a partir de ampla revisão da literatura, para construção de um protocolo de atendimento assistencial, utilizando as principais bases eletrônicas (MEDLINE, LILACS e Cochrane).

Resultados: Descrevemos a construção de uma ferramenta de segurança do paciente com suas inúmeras modificações e adaptações, a partir das observações da equipe multidisciplinar com seu uso na prática diária.

Conclusão: A aplicação do checklist na manobra de prona acrescentou confiabilidade e segurança ao procedimento. O entendimento da importância da ferramenta na segurança do paciente, por parte da equipe, e sua capacitação são necessários para seu sucesso.

Objetivo: Construir e implementar um instrumento (checklist) para melhoria do cuidado na manobra prona.

Métodos: Estudo aplicativo, qualitativo e descritivo. O instrumento foi desenvolvido a partir de ampla revisão da literatura, para construção de um protocolo de atendimento assistencial, utilizando as principais bases eletrônicas (MEDLINE, LILACS e Cochrane).

Resultados: Descrevemos a construção de uma ferramenta de segurança do paciente com suas inúmeras modificações e adaptações, a partir das observações da equipe multidisciplinar com seu uso na prática diária.

Conclusão: A aplicação do checklist na manobra de prona acrescentou confiabilidade e segurança ao procedimento. O entendimento da importância da ferramenta na segurança do paciente, por parte da equipe, e sua capacitação são necessários para seu sucesso.

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Conflict of interest statement

Conflicts of interest: None.

Figures

Figure 1
Figure 1
Flow diagram of the prone position care protocol. ARDS - adult respiratory distress syndrome; FiO2 - inspired oxygen fraction; PaO2 - partial oxygen pressure; MV - mechanical ventilation; IV: intravenous; RV - right ventricle; PIA - intra-abdominal pressure; SpO2 - oxygen saturation; CRA - cardiorespiratory arrest; P/F - ratio of partial oxygen pressure to inspired oxygen fraction.
Figure 2
Figure 2
Cushions for face, chest, pelvis and wrist.
Figure 3
Figure 3
Placement of the cushions on the chest and pelvis before the envelope maneuver is performed.
Figure 5
Figure 5
Envelope Maneuver. Step 2: Join and wrap the top and bottom sheet as closely as possible to the patient's body.
Figure 4
Figure 4
Envelope Maneuver. Step 1: Position the top sheet over the lower sheet. Place drains, tubes and invasive pressure transducer inside the envelope.
Figure 8
Figure 8
Envelope Maneuver. Step 5: End of rotation and prone positioning and start of post-maneuver care.
Figure 9
Figure 9
Post-maneuver care (check the placement of the cushions, keeping the abdomen free).
Figure 10
Figure 10
Swimmer's position (one arm raised and head rotated toward the raised arm; the other arm is positioned alongside the body).
Figure 11
Figure 11
Latest version of the safe prone maneuver checklist (time in, performance of maneuver and time out). Front and back of the sheet with guidelines for the team and prone protocol in flowchart format. NET - nasoenteric tube; BIS - bispectral index; MV - mechanical ventilation; ETT - endotracheal tube; TCT - tracheostomy; FiO2 - inspired fraction of oxygen; MAP - invasive mean arterial pressure; ULs- upper limbs; PTN - parenteral nutrition; AS - airways; PaO2 - partial oxygen pressure; PaCO2 - partial carbon dioxide pressure; pH - hydrogen ion concentration; SatO2 - oxygen saturation; peakp - peak pressure; platp - plateau pressure; PEEP - positive end-expiratory pressure.
Figure 12
Figure 12
Front and back of the checklist for return to supine position. NET - nasoenteric tube; BIS - bispectral index; MV - mechanical ventilation; ETT - endotracheal tube; TCT - tracheostomy; MAP - invasive mean arterial pressure; ULs - upper limbs; PTN - parenteral nutrition; AS - airways; FiO2 - inspired oxygen fraction; ARDS - adult respiratory distress syndrome; RV - right ventricle; SpO2 - oxygen saturation; PaO2 - partial oxygen pressure; PIA - intra-abdominal pressure; P/F - ratio of partial oxygen pressure to inspired oxygen fraction.
Figure 6
Figure 6
Envelope Maneuver. Step 3: Start turning the patient on the physician's command. Move the patient to the side of the bed opposite the mechanical ventilator.
Figure 7
Figure 7
Envelope Maneuver. Step 4: Turn the patient to lateral position. Perform the hand exchange maneuver among the team by placing one hand on the left side and one on the right side of the patient.
See this image and copyright information in PMC

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