RATIONALE: An intervention program addressed the effectiveness of a pressure-relieving heel protector for pressure ulcer prevention and treatment. Archbold Medical Center is a system that includes 5 acute care hospitals, a psychiatric hospital, 4 swing bed facilities, 4 nursing homes, 2 hospice groups, 2 home health agencies, and an urgent care. The intervention program evaluated long-term results of the heel pressure relieving device based on the success of a 10 week trial in the IMCU (Intermediate Care Unit) of the flagship hospital and one nursing home. Prior to the trial period, multiple pressure relieving devices were used with little success.

METHODS: All patients were evaluated for risk of pressure ulcers using the Braden scale. Patients 18 or below on the Braden scale were placed into the protocol. Other inclusion criteria included inability to move legs, hip fracture, hip surgery, and decreased sensation or numbness in the legs. Outcome criteria included durability of the device, comfort of the patient, suspension of the heel, and prevention of pressure ulcers on the Achilles, malleoli, heel, and foot. Integumentary evaluation was performed with visual inspection every shift. Validation of efficacy required 4 successful outcomes in the IMCU and 12 successful outcomes in the nursing home.

OUTCOMES: No pressure ulcers occurred during the intervention period. At initiation of the trial, 1 patient with multiple pressure ulcers from friction and shear due to thrashing in bed had complete closure of wounds. Two patients with Stage IV heel ulcers demonstrated progress toward healing, with ultimate complete closure. The device was found to be efficacious in the sitting position and in bed. The durability of the boot held up after being put through the non-commercial washer and dryer during the trial. Efficacy was demonstrated with documentation of the 4 successful IMCU outcomes and 12 successful nursing home outcomes.