Page 83 - COVID-19 Inpatient Training Resources

Document Name: COVID-19 Guidelines for Initiation and Titration of O2 in the COVID-19 Adult Patient
Developed Date: 2020 04 21
Expiry Date: 2021 04 21
Distribution Approved by: Incident Management Committee
Contact for suggestions for next version: CPL, Charge RT, Dr. David Casey (GIM physician)
Intended use: SJHC site; for reference at SMH and Providence

Steps:
1. Verify Order
2. Explain procedure and obtain verbal consent. Provide patient with copy of patient education
handout. See Appendix C
3. Assist the patient to the prone position and ensure the following:
a. Oxygen therapy is in place with adequate length on tubing to facilitate position changes
b. Call bell within reach
c. Medical devices (IV lines/Catheters/Tubes/Drains) are secure and have adequate length
on tubing to facilitate position changes
d. Assess skin integrity for all pressure points/bony prominences. See Appendix B for
pressure points specific to prone position.
e. Implement pressure injury prevention strategies:
i. Pillows under chest, hips and knees may aid comfort.
ii. Instruct patient to shift position slightly every 15 minutes to redistribute
pressure.
iii. Apply prophylactic dressings (Mepilex Border) to applicable areas
iv. Utilize pressure redistribution mattress for bed and/or stretcher
v. Consult CNS for Skin, Wound & Ostomy for skin/pressure injury prevention and
management if required.
f. Can use reverse trendelenberg to aid comfort
g. Bed rails in situ x3 sides or if in stretcher one rail raised.
4. Instruct the patient to switch positions as follows:
a. 30 minutes to 2 hours lying fully prone (bed flat or reverse trendelenberg)
b. 30 minutes to 2 hours lying on right side (bed flat)
c. 30 minutes to 2 hours sitting up (30-60 degrees) by adjusting head of the bed
d. 30 minutes to 2 hours lying on left side (bed flat)
e. 30 minutes to 2 hours lying prone again
f. Repeat Cycle

5. Monitor Sp02 for 15 minutes after each position change. Continuous SpO2 monitoring could be
implemented if available to facilitate frequent monitoring.
6. Monitor patient for changes in respiratory status and contact REACT or MRP when oxygen
requirements exceed 40% Fi02 or 6 liters of oxygen or when patient demonstrating signs of clinical
deterioration
7. Document care provided

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Version 3.1 August 17, 2020