Proning Patients Checklist

Staff Requirements | Minimum

▪ 4 RNs/NAs
▪ 1 RT

Supplies
▪ 4 Mepilex sacral ▪ 6 pillows
▪ 4 Mepilex boards 4x4 ▪ 1 flat sheet
▪ 1 Z-flo pillow ▪ 2-3 Premium pads

Checklist
1. Perform hand hygiene.
2. Verify the correct patient by 2 identifiers
3. Assess for adequate sedation and analgesia
4. Perform eye care.
5. Ensure all lines, tubes, and drains are secure.
6. Change any dressings that will due during pronation therapy.
7. Apply Mepilex to forehead, chin, sternum, shoulders, hips, and knees. (Mepilex sacral to knees and hips)
8. Pause enteral feeds.
9. Suction patient’s mouth and down the endotracheal tube.
10. Have staff take their positions around the bed. (RT at head of bed managing the airway, 2 RN/NA’s on
each side of the bed)
11. Talk aloud with team to come up with a plan for positioning the patient prone. (Majority of the time it is
easiest to place a patient prone by turning towards the vent)
12. Make sure all lines and drains are properly placed so they will not end up under the patient s/p prone
positioning. ( if the patient has an IJ it is suggested to place the pumps at the head of the bed/if the patient
has a femoral line it is suggested to place the pumps at the foot of the bed)
13. Detach/remove any lines that are not critical to patient’s care while positioning them prone. This helps
decrease tangling and risk of losing lines during prone positioning.
(IMPORTANT: Do not detach the suction tubing to the in-line suction on the endotracheal tube. Secretions
are mobilized during prone positioning that requires timely suctioning to keep the patient’s airway patent.)
14. Remove EKG electrodes from the patient’s chest.
15. Place a premium pad and a pillow over the sternum and pelvis. (this will help keep the spine in a neutral
position while the patient is prone)
16. Remove the patient’s gown.
17. Place a new flat sheet over the top of the patient and sternum and pelvic pillows. Fold the top part of the
sheet down in order to keep patient’s airway in view.
 18. Team members on the side of the bed the patient will be turning towards to be placed prone will roll the
new top linens and current bottom pull sheet downward. Ending with the sheets intertwined.
19. Team members on the side of the bed that the patient will be turning away from will roll the new top linens
and current bottom pull sheet upward.
 End product should be the patient cocooned with the old and new linen.
20. Position patient on the edge of the bed that the patient will be turning away from.
21. On the RT’s call the team members with the sheets rolled downward will push downward while the team
members on the other side pull upwards to put patient in a side lying position.
22. Pause in the side lying position for team members to adjust hand positions and RT to check patency of the
patient’s airway.
23. On the RT’s count team members will lower patient to the prone position.
24. Pull the top folded part of the flat sheet out.
25. Place Z-flo pillow underneath the patient’s head ensuring that all high-pressure areas are caved out in the
pillow to adequately distribute the pressure load. (i.e. ear free floating, eye not compressed in to pillow,
chin free floating)
26. Reattach EKG electrodes to the patients back. (Electrode placement is the same as when the patient is
supine white and green on the patient’s right and black on the patient’s left.
27. The arm on the side that the patient’s head is turned towards should be up, so that hand is at the top of
the bed. (swimmer’s position) The opposite arm can remain neutral at the patient’s side. Use pillows under
each arm to help relieve pressure.
28. Place a pillow under each leg. The leg on the side of the up arm can be in a flexed position lying off the
patient’s side. On the opposite leg try to ensure the knee is free floating to decrease pressure on the area
and monitor the position of the foot in order to prevent foot drop/hyperextension at the ankle.
29. Put the bed in reverse Trendelenburg.
30. Place the patient on CLRT.

Monitoring and Maintenance Care

▪ Consult Wound/Ostomy Nursing for them to come assess prone position and offer recommendations to
prevent skin breakdown.
▪ The patient’s head should be turned q2hours from one side to the other.
▪ Monitor Z-Flow pillow. These pillows can be manipulated periodically to change the pressure barring areas
by just pushing down on the area of the pillow that appears to be supporting a high-pressure load.
▪ Repositioning of extremities should be done at this time as well.
▪ Maintain prone position for the amount of time identified by LIP (usually 18 hours)

Documentation
▪ Prone position can be charted in the Adult Flowsheet in Epic under the Mobility Heading; Row – Position.
▪ q 2-hour head and extremities repositioning
▪ Length of time in the prone position
Mepilex Locations Premium Pads & Pillow Locations