Development of prone positioning and skin damage prevention digital education: The PRONEtect project

Objective: The incidence of skin/tissue damage, such as pressure ulcers, remains high in mechanically ventilated patients in the prone position. According to guidelines, critically ill patients with acute respiratory distress syndrome (ARDS) should be prone for at least 12-16 hours to improve oxygenation and decrease mortality. Therefore, educating clinicians on how to reposition and manage the patient safely in a prone position plays a vital role in preventing adverse events. This project aimed to develop accessible online educational content to assist clinicians in safely executing the prone manoeuvre and minimise skin/tissue damage. Method: The development of the educational content was based on: a gap analysis and comprehensive review of available educational resources; evidence-based scientific literature; advice from international experts; and a qualitative study exploring the learning needs of 20 clinicians in Belgium and Sweden between February-August 2022. Results: Volunteer clinicians assisted with the creation of eight simulation videos which were professionally filmed and edited. The interactive videos included the supine-to-prone and prone-to-supine manoeuvres, endotracheal and nasogastric tube securement, eye care, stoma care, protecting high-risk areas from pressure damage, and incontinence-associated dermatitis prevention. A prone positioning protocol, a checklist summarising the key aspects of the protocol, and teaching aids (slide deck for didactic lecturing) were developed and validated by a review of the relevant evidence-based literature and the international expert panel. A website was designed to host the content, with free user access, at www.pronetection.com. Conclusion: Education is one strategy towards prevention of complications of prone positioning. Accessible education could assist clinicians unfamiliar with prone positioning or current clinicians requiring refresher training to safely manage patients in this position. Declaration of interest: Authors AF, DB, AG, SS, YW, HHC and KL have no competing interests to declare. JB and FC declare being consultants and speakers for Mölnlycke Health Care AB, Sage: A Division of Stryker, and Mobility is Medicine. KV declares being a consultant and speaker for Sage: A Division of Stryker, and Mobility is Medicine. MA declares serving as an advisory board member for Mölnlycke Health Care AB during 2022. There was no external funding. The design and development of the educational resources were funded by the strategic research funds of the Skin Integrity Research Group (SKINT) at the University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium. Multimedia support costs were funded by an in-kind contribution from HOGENT University of Applied Sciences and Arts, Ghent, Belgium.