Steps to Prone the COVID-19 Patient Proning Team:

1. COVID Attending (Team

Leader)—@ HOB
Ensure Prepare to Turn Patient (follow steps below in order): 2. Nurse—@ side across
order to 1. Untangle lines & cables from vent
prone 2. Remove patient clothing 3. Respiratory Therapist—
3. Place foam dressing on pressure points @ side of vent
4. Place eye pads (ensure lids fully closed) 4. Nurse (optional)--@
5. Change ETT holder (tape or alternative device) either side of bed
6. Attend to NGT/OGT: (a) suction & (b) disconnect
7. Attend to Foley catheter: (a) remove stat-lock & (b) empty foley bag
8. Disconnect all non-necessary tubing
9. Ensure at RASS -5 (+/- paralysis)
10. Ensure MV at correct mode as per provider/RT
11. Ensure SpO2 monitor functioning properly
12. If patient has arterial line, ensure working properly
13. Ready the bed: (a) lock in place & (b) max inflate
14. Ensure re-intubation equipment (including video laryngoscope) is just outside room door

Pre-Turning Phase 1 2
(follow steps below in order): Team leader Slide patient as
1. Assemble 3-4 person proning team announces whether directed by team
2. Leader call for time-out turning patient leader on count of 3
3. Move ventilator close to bed towards/away from (away from vent if to
4. Ensure IV access is secured and visible turn towards vent)
the ventilator
5. Remove head pillow.
6. Remove EKG leads & patches
4 3
6 5 Place clean flat Tuck patient
Place 2 pillows/
Turn patient 90 sheet next to hand under
wedges over new flat
degrees as directed patient (on side will buttock (hand to
sheet
by team leader on turn towards) & be under patient
(place at the level of
count of 3 tuck under patient during turn)
the clavicle & anterior
(now lying on side) iliac crest)
10
9 Turn patient 90 degrees Slide patient to
7 8
Pull new flat as directed by team center of bed
Remove old sheet under leader on count of 3 on count of 3
flat sheet (now lying prone in bed)
patient
11
13 12
Reconnect Ensure patient position ok:
Apply new 1. Adjust pillows/wedges
all
Cover patient EKG leads 2. Turn head to one side & place
disconnected & patches pillow under head
tubes/IVs
3. Confirm eyes fully closed
4. Ensure no ear kinking
5. Place arm/leg wedges/pillows
6. Place arms in swimmers’ pose

Page 1 of 2
reviewed Feb. 2021
 MAINTAINING PRONE POSITION:
1. Maintain prone position for at least 16 hours or as patient tolerates
Supining Team:
2. Every 4 hours: 1. COVID Attending (Team
1. Turn patient’s head to the other side (MD or RT must be present)
Leader)—@ HOB
2. Alternate position of arms (up/down)
2. Nurse—@ side across
3. Perform slight side-to-side turns
from vent
3. Maintain patient in slight reverse Trendelenburg
3. Respiratory Therapist—
4. Obtain ABG as per MD
@ side of vent
5. Ensure eye lids are tightly closed (remove tape, apply & re-tape) 4. Nurse (optional)--@
6. Apply eye drops as per order either side of bed
7. Ensure no ear kinking
8. Ensure patient’s tongue positioned inside mouth

Steps to Supine the COVID-19 Patient

Prepare to Turn Patient (follow steps below in order):
1. Untangle lines & cables
2. Attend to NGT/OGT: (a) suction & (b) disconnect
3. 1 (a) remove stat-lock & (b) empty foley bag
Attend to Foley catheter:
Ensure 4. Disconnect all non-necessary tubing
order to 5. Ensure SpO2 monitor functioning properly
6. If patient has arterial line, ensure working properly
supine
7. Ensure IV access is secured and visible
8. Ready the bed: (a) lock in place & (b) max inflate
9. Ensure re-intubation equipment (including video laryngoscope) is
just outside room door

4 3 2 1
Tuck patient Slide patient as Team leader Pre-Turning Phase
hand under directed by team announces (follow steps below in order):
thigh (hand leader on count whether turning 1. Assemble 3-4 person supining team
to be under of 3 (away from patient 2. Leader call for time-out
patient vent if to turn towards/away 3. Move ventilator close to bed
during turn) towards vent) from the 4. Remove arm/legs/head pillows &
ventilator place arms down
5 5. Remove EKG leads & patches
Place clean flat 6
Turn patient 90 7
sheet next to
degrees as directed Remove 8 Turn patient 90 degrees
patient (on side will pillows as directed by team
by team leader on
turn towards) & count of 3 that were leader on count of 3
tuck under patient under (now lying supine in bed)
(now lying on side)
patient
13 12 11 10 9
Reconnect all Apply new Slide patient to Pull new flat Remove old
disconnected EKG leads center of bed sheet under flat sheet and
tubes/IVs & patches on count of 3 patient pillows/wedges
14 15
Assess skin under Apply ice packs to face (if
Cover patient
foam dressings ordered by MD)
Page 2 of 2
reviewed Feb. 2021