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Automatic Rotating Pronation Beds

Automatic Rotating Pronation Beds

Technology has improved the manner in which care is delivered today. It has enhanced the safety of care and helps to improve person-centered care, which results in increased customer satisfaction. One of the most recent technologies in healthcare is automatic rotating pronation beds. This technology is commonly used among patients with acute respiratory distress syndrome. It is commonly used among critically ill patients who are often immobile. A fictional case of a client in the ICU presenting with acute respiratory distress syndrome exacerbated by the coronavirus is used in this case. This technology is relatively new and will require the training of nurses to avoid or minimize possible risks associated with its use.

Explanation and Background

Automatic rotating pronation beds make use of kinetic therapy beds to give practical strategies that can increase oxygenation for patients who are critically ill. The main population in which this technology is used in, is patients with acute respiratory distress syndrome. Critically ill and immobile patients benefit from a prone position, and therefore the use of automatic rotating pronation beds have become common among physicians. The technology is currently used in 51 states in the US (ARDS Foundation, 2021). The goal of proning is to match perfusion and ventilation by lessening the pressure on lungs from the abdominal contents, added weight of edematous lungs as well as the heart and the supporting structures (Bell, 2020). The ideal pronation length is 12 to 20 hours. In manual proning, the physicians turn the patient onto one side, then finish the turning after reviewing tubes and lines between turns to prevent adverse events (McKenney, 2020).  However, some patients might be heavier, and complications might arise during turning, and therefore automatic proning eliminates such risks.

Automated prone positioning, using kinetic therapy bed, is considered an effective and safe means of improving oxygenation in patients who are critically ill with ARDS. Automated proning can be beneficial in that; it is likely to address caregiver risk management concerns; it requires minimal staff to prone patients; separate hand control enables caregivers to monitor patient lines and tubes during rotation; touch-screen controls automatically control the therapy system and tube management system helps to secure patient lines during rotation (ARDS Foundation, 2021).

Risks and Benefits

Patients with ARDS normally have large zones of dependent atelectasis, which contributes to intrapulmonary shunt. Positive end expiratory pressure has been commonly utilized and has shown to enhance intrapulmonary shunt as well as oxygenation (Cater et al, 2020). However, the heterogeneous nature of ARDS makes the use of PEEP to cause recruitment of dependent ataractic lung as well as overextension on other regions of the lung (Cater et al, 2020). The use of automatic rotating pronation beds can help improve ventilation or perfusion matching and can provide increased homogenous distribution of positive end expiratory pressure. Manual prone patient positioning might prove challenging, particularly for large patients. The number of providers together with the ability to turn patient and physical strength might complicate care. However, the use of automatic rotating pronation beds has eased this, eliminating some of the weaknesses of a manual rotating bed.

In a research conducted by Morata et al (2021), to compare automatic and manual prone positioning, results showed that pressure injuries were more common on the head and lower extremities of patients that had been automatically pronated. Furthermore, the technology was associated with increased interruptions and complications during therapy as compared to manual prone positioning. Automatic rotating pronation beds are also highly costly and hence might not be easily implemented in small hospitals. Complications can be mitigated by close monitoring of patients’ pressure and frequent checks of signs of multi-organ failure. Kwee, Ho and Rozen (2016) recommend upward traction on the head to ease pressure off the face. Carefully planned positioning as well as supportive padding, which are meant to ease pressure off key structures, can help ease complications during proning.

Interdisciplinary Team’s Role and Responsibilities

Patients with acute respiratory distress syndrome require complex ventilation strategies that require highly skilled nurses working in collaboration with respiratory therapists, physicians and a pharmacist to closely monitor the patient’s respiratory status (Costa et al, 2018). Prone positioning requires the caregivers to strategically maneuver the patient into the prone position and at the same time ensure endotracheal tube and intravenous lines remain in place.  Intensivist physicians or board-certified critical care physicians will be needed to provide evidence-based care processes. There will also be a need for a pharmacist who should ensure effective administration of correct drugs at the required time to the right patient to prevent adverse drug events. A respiratory therapist will be needed to help promote faster weaning from mechanical ventilation to ensure safe and effective care. The respiratory therapist will need to ensure proper management of the ventilator, perform diagnostic blood sampling, ensure specialized gas administration, and help in bronchoscopy assistance and every aspect of hemodynamic monitoring (National Institute of Health, 2020).

ICU nurses will also be needed to monitor certain aspects of the patient, such as their pressure during pronation, check for signs of pressure sores, and offer skincare. Nurses need to be vigilant in monitoring the vital signs of the patient and their response to medications. The clinical nurse plays an integral role in the care of the patient before placement of the patient in the prone position as well as while they are in that position. The nurse assesses any alterations that might take place due to the prone position. The patient’s nurse plays a vital role in enabling collaboration among all the interdisciplinary team members. A short meeting led by the nurse should be conducted to reinforce the communication of the procedures, orders, and any other requirements that might be needed before placing the patient in a prone position as well as the time required to conduct those tasks (Mitchell & Seckel, 2018). When these individuals work in collaboration with each other, there will be improved outcomes for the patient, including increased survival rate, lower costs as well as shorter length of stay in the ICU.

Nursing Scope of Practice

The treatment of a patient with ARDS requires the input of skilled nurses. These nurses need to have knowledge of how the technology works to prevent any complications that might arise in the process. Nurses play an important role in assessing the condition of patients before, during, and after proning. In this case, the nurse will need to have the knowledge of how proning is done to ensure safe and effective care. The registered nurse will need to have technical skills in how the technology works. The nurse should also have leadership skills that are relevant in coordinating the interdisciplinary team. The nurse should be able to offer prone positioning guidelines, facilitate communication of the plan, make sure that proper orders are written, and team members are well prepared for adverse events that might occur when placing the patient in a prone position (Mitchell & Seckel, 2018). The nurse should maintain a professional attitude in the care of the patient. This would mean ensuring effective communication, sense of duty, caring, and accountability during the care of the patient.

Patient Education

Patient education is an important process in the treatment and recovery of the patient suffering from ARDS. Treatment of the disease is supportive and requires mechanical ventilation, nutritional support, prophylaxis for stress ulcers as well as treatment of any underlying injury (Saguil & Fargo, 2017). Research shows that patients who survive ARDS are at higher risk of reduced functional capacity, reduced quality of life, and mental illness (Saguil & Fargo, 2017). This means that ongoing care of the patient by a primary care physician will be important. It will be important for the patient and their family to be educated on the care of the patient in the event that he is released from the hospital. This education should be done verbally and coupled with a manual description of the care of the patient. This should contain nutritional guidelines, resources for mental health support, and care of any injuries that might arise from pronation. The success of the education will be measured based on how quickly the client recovers after being discharged or reduced hospitalization.

Conclusion

Acute respiratory distress syndrome is a life-threatening lung injury that permits fluid to leak into one’s lungs. This makes breathing difficult, and oxygen is unable to get into the body. Most of these patients are in critical conditions requiring urgent care. ARDS patients benefit a lot from pronation. The use of automatic rotating pronation beds are important during the pronation period. This technology is quite costly but is linked with such benefits as improved ventilation, reduced injuries or errors during turning of a patient, and requires minimal staff. An interdisciplinary team composed of a nurse, respiratory therapist, physician, and pharmacist can help in the patient’s recovery. This recovery can be boosted through patient education conducted verbally and using a manual with guidelines on patient care.

References

Bell, L. (2020, April 9). ARDS, COVID-19 and Pronation Therapy. American Association of Critical Care Nurses. Retrieved from https://www.aacn.org/blog/ards-covid-19-and-pronation-therapy

Cater, D. T., Ealy, A. R., Kramer, E., Abu-Sultaneh, S., & Rowan, C. M. (2020). The Use of a Kinetic Therapy Rotational Bed in Pediatric Acute Respiratory Distress Syndrome: A Case Series. Children7(12), 303.

Costa, D. K., Barg, F. K., Asch, D. A., & Kahn, J. M. (2018). Facilitators of an interprofessional approach to care in medical and mixed medical/surgical ICUs: a multicenter qualitative study. Research in nursing & health37(4), 326-335.

Kwee, M. M., Ho, Y. H., & Rozen, W. M. (2016). The prone position during surgery and its complications: a systematic review and evidence-based guidelines. International surgery100(2), 292-303.

McKenney, T. (2021). Automated Versus Manual Proning of Patients with ARDS. Retrieved from https://sizewise.com/Sizewise/files/4a/4a335b2e-cf7b-4163-84b3-550e268b23be.pdf

Mitchell, D. A., & Seckel, M. A. (2018). Acute respiratory distress syndrome and prone positioning. AACN advanced critical care29(4), 415-425.

Morata, L., Sole, M. L., Guido-Sanz, F., Ogilvie, C., & Rich, R. (2021). Manual vs Automatic Prone Positioning and Patient Outcomes in Acute Respiratory Distress Syndrome. American Journal of Critical Care30(2), 104-112.

National Institute of Health. (2020). Critical Care Medicine Department: Critical Care Therapy and Respiratory Care Section (CCTRCS). Retrieved from https://www.cc.nih.gov/ccmd/services/cctrcs.html

Saguil, A., & Fargo, M. V. (2017). Acute respiratory distress syndrome: diagnosis and management. American family physician85(4), 352-358.

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Automatic Rotating Pronation Beds

NR341/342 Complex Adult Health

Automatic Rotating Pronation Beds

Automatic Rotating Pronation Beds

RUA Interdisciplinary Management of Healthcare Technology Guidelines

NR341_RUA_Interdisciplinary_Management_of_Healthcare_Technology_Guidelines_v4

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