Virginia Research Day 2021

SUCCESSFUL RESIDENT-LED EDUCATION AND UTILIZATION OF VENTILATOR PRONE POSITIONING Andrew Wyker, DO; Ji Moon, DO; Elizabeth Ullrich, DO; Kimberly Bird, MD Sovah Internal Medicine Residency Program, Danville, VA

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Background: There has been a national nursing shortage for the past 20 years and no long-term solution is in sight. Community hospitals have felt the impact of this shortage the most. This has been compounded by the relatively high turnover of ICU nurses during the Covid pandemic. This turnover requires individualized nurse training of new skills to nurses by nurses who are in a very high stress, critical care environment. Prone Positioning of Ventilator Patients (PPVP) is one such critical ICU treatment. The Prone Severe ARDS Patient Study (PROSEVA; New Engl J Med 2013;368:2159) found that early application of prolonged ventilator prone- positioning sessions significantly decreased 28-day and 90-day mortality. Having individuals other than an ICU nurses train ventilator proning would be of great benefit to ICU care. Objective: This study was done to determine if training Internal Medicine (IM) and Family Medicine (FM) residents in an academic community hospital to be “teachers of ventilator prone positioning” for nurses and respiratory therapists could make PPVP more readily available. Methods: The Sovah Health Medical Residency Program has 24 IM and 18 FM residents who were trained to teach ventilator proning position utilizing a proning protocol checklist, the PROSEVA article, a PowerPoint presentation, a YouTube video presentation, and a hands-on exercise to ICU nurses and respiratory therapists. Each month, residents on ICU rotation received reinforced training in the process. Anonymous resident surveys (1-10 response range with 10 being very comfortable) were done at the end of each training session to measure their comfort level with PPVP teaching, implementation, and use. Surveys were done after residents had participated in PPVP training.

Results: On the baseline survey, residents had a mean comfort level of 7.5 in suggesting alternatives/improvements to PPVP. Over 10 months, this improved to 8.67 (15% increase). They had a baseline mean 8.5 score on recommending PPVP to attendings. This rose over 10 months to a mean of 9.66 (14% increase). Residents’ baseline comfort in participating in PPVP was always high being a mean of 9.5 at baseline and rising to a mean of 10 on the final survey. Finally, the residents’ comfort teaching PPVP stayed the same over the initial 10 months at 7.5.

Discussion: This study sought to evaluate the comfort of residents in being trained to teach PPVP process which could potentially expand the use of PPVP. Residents trained in proning ventilator patients trained ICU nurses and respiratory therapists. Although the residents had an overall relatively high comfort level with the training at baseline, there was improvement in overall comfort levels regarding PPVP. While the program began as a way to help ARDS patients, it was extremely beneficial in the Covid 19 pandemic with the great increase in ventilator patients. Many COVID-19 ventilator patients were successfully proned allowing less need for transfer to tertiary centers. In addition to increasing the availability of PPVP to patients, resident led training was able to assist with in-service training of new ICU nurses which has been often needed during the pandemic.

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