Background The COVID-19 pandemic has created challenges for provider teams working in intensive care units, including rapidly changing patient care regulations, staffing considerations, and preservation of personal protective equipment. The need for enhanced respiratory precautions for infected patients and patients under investigation has necessitated a new process for interventions and resuscitation. Local Problem Along with changing regulations and equipment, significant staff anxiety surrounded caring for infected patients and preparing for emergency situations. Methods A huddle process was implemented in the pediatric cardiac intensive care unit for acutely ill patients who required enhanced respiratory precautions and were at risk of imminent decompensation, or who required a bedside procedure. During a huddle, the multidisciplinary team used process maps displayed in patient rooms; the huddle process created a situational awareness of events among these teams. Intervention After implementation of huddles, a survey was distributed to cardiac intensive care unit staff in order to understand their satisfaction with the huddle process. Results A total of 36 staff responded to the survey. They thought the huddles helped them to prepare for resuscitation scenarios, helped limit the number of personnel responding to an emergency, and reduced their anxiety surrounding caring for these patients. Staff suggested generalizing this huddle process to all patients at acute risk for decompensation in the cardiac intensive care unit. Conclusions A novel huddle process created situational awareness among staff caring for patients requiring enhanced respiratory isolation because of COVID-19. Multidisciplinary huddles allowed staff from various disciplines to apply a process map for interventions and resuscitations among critically ill children with heart disease.

Background Prone positioning is a well-known beneficial intervention for patients with acute respiratory distress syndrome. As the COVID-19 pandemic emerged, hospitals rapidly adapted prone positioning for acutely ill patients into a new process: awake self–prone positioning. Could a large health care system safely and rapidly implement awake self–prone positioning in COVID-19 units to prevent respiratory failure from progressing among a surge of inpatients? Review of Evidence The team extensively reviewed the literature. Using evidence from 22 case reports, peer-reviewed standards, and studies, they developed an awake self–prone positioning guideline. Implementation The guideline was implemented in April 2020 in critical care and COVID-19 units. Multimodal education included a concise guideline and real-time support from intensive care unit nurses, clinical nurse specialists, and nursing professional development specialists. Evaluation Awake self–prone positioning was a new procedure, and relevant data were obtained from the electronic medical record. From March 18 to August 5, 2020, 1000 COVID-19–related admissions occurred; 272 patients had a high-flow nasal cannula, 111 (41%) of whom had documentation of awake self–prone positioning. Sustainability This guideline is now an established part of COVID-19 care and has been integrated into practice in units caring for patients with the disease. Conclusions Nurses adapted quickly to using awake self–prone positioning as a plan of care for hypoxic patients. This practice may help hospitals adjust care delivery for these patients and effectively maintain patients in non–intensive care units. ( Critical Care Nurse . Published online April 13, 2021)