• Karen A Allicock, Danielle Coyne, Anna N Garton, Erin C Hare, and Maureen A Seckel.
• Karen A. Allicock is a nursing professional development specialist II, Christiana Hospital, Newark, Delaware.
• Crit Care Nurse. 2021 Oct 1; 41 (5): 23-33.

BackgroundProne positioning is a well-known beneficial intervention for patients with acute respiratory distress syndrome. As the COVID-19 pandemic emerged, hospitals rapidly adapted prone positioning for acutely ill patients into a new process: awake self-prone positioning. Could a large health care system safely and rapidly implement awake self-prone positioning in COVID-19 units to prevent respiratory failure from progressing among a surge of inpatients?Review Of EvidenceThe team extensively reviewed the literature. Using evidence from 22 case reports, peer-reviewed standards, and studies, they developed an awake self-prone positioning guideline.ImplementationThe guideline was implemented in April 2020 in critical care and COVID-19 units. Multimodal education included a concise guideline and real-time support from intensive care unit nurses, clinical nurse specialists, and nursing professional development specialists.EvaluationAwake self-prone positioning was a new procedure, and relevant data were obtained from the electronic medical record. From March 18 to August 5, 2020, 1000 COVID-19-related admissions occurred; 272 patients had a high-flow nasal cannula, 111 (41%) of whom had documentation of awake self-prone positioning.SustainabilityThis guideline is now an established part of COVID-19 care and has been integrated into practice in units caring for patients with the disease.ConclusionsNurses adapted quickly to using awake self-prone positioning as a plan of care for hypoxic patients. This practice may help hospitals adjust care delivery for these patients and effectively maintain patients in non-intensive care units.©2021 American Association of Critical-Care Nurses.

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