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Archive March 2019 XX, No. 3

Perfecting the Prone Position

By adding a methodical, aviation-like checklist that focused on teamwork, we reduced repositioning and patient injuries.

Denise Lawyer

Denise Lawyer, BSN, RN, CNOR


Lehigh Valley Health Network
UP AND DOWN Our positioning protocol checks each pressure point along the way: first starting at the head and working our way down to the feet, and then starting at the feet and moving up to the head.

We place many of our neuro patients in the prone position. Until recently, we were also re-positioning them in the prone position. Quite a bit. Not good. The more you move patients in prone, the more likely they'll suffer the adverse effects of poor positioning — post-op pain, brachial-plexus injuries to the shoulders, arms and hands, and, of course, skin breakdown and pressure ulcers.

In an effort to prevent this needless suffering, we took a step back and asked ourselves, "What are we doing wrong and how can we fix it?" What we came up with was a methodical, team-based system for preventing prone positioning injuries that you can apply to all types of surgical positioning. Here's a detailed breakdown of our approach.

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