Table 1.

Strategies to improve adherence to awake prone positioning

Location	General ward	Intermediate care unit	ICU
Resources
Patient: nurse ratio	1: 0.3 to 1:1.1	1: 0.5 to 1:1.5	1:1.6 to 1: 2.9
Patient: family member	1:1 to 1:1.5	1:1 to 1:1.5	NA
Respiratory support	Low flow oxygen delivery devices	Low flow oxygen delivery devices High-flow nasal cannula Noninvasive ventilation	Low flow oxygen delivery devices High-flow nasal cannula Noninvasive ventilation Invasive mechanical ventilation ECMO
Supervisor of prolonged awake prone positioning	Doctors Nurses Family members		Doctors Nurses
Recorder of prolonged awake prone positioning	Prone position time was recorded by family members Nurses accumulated prone position time every 8 h (each shift)		Nurses recorded and accumulated prone position time
Strategies	Education	Rounds	Education	Monitoring
Objective	Patients Family members	Patients Family members	Patients	Patients
Time	Just after hospitalization (admission education) Once daily (during doctor rounds)	Every two hours nurse rounds during the daytime (8:00–18:00) At least once per night	Admission to ICU Once daily (during physician rounds)	Continuous monitoring
Content	• Explanation of underlying treatment rationale and possible effects of awake proning • Try comfortable prone position • How to record prone position time	• Help identify comfortable prone position • Provide appropriate supervision • Inform the treatment effects of prone positioning • Music used as a distraction • Analgesics and sedatives if necessary (In intermediate care unit)	• Underlying treatment principles and effects of awake proning • Identify comfortable prone position • Education on use of buttons on the bed to help a comfortable position	• Identify comfortable prone position • Provide appropriate supervision • Educate treatment effects of prone positioning • Music used as a distraction • Analgesics and sedatives if necessary

ECMO extracorporeal membrane oxygenation; ICU intensive care unit