Introduction

Patients admitted to intensive care units are at high risk for the development of heel ulcers due to the severity of their illness and prolonged immobility.

 Methods

The 2006 data collected on facility acquired pressure ulcers, revealed that 40 % were located on the heel. Of the total number of heel ulcers, 50% were acquired in the Intensive Care Unit (ICU), and of these 100% developed in ventilator dependent patients.

A comprehensive plan was developed to examine and reduce the incidence of heel ulcers in the ICU. The plan included continued monitoring and data collection, providing education to the ICU staff, and adding heel boots to the ventilator associated pneumonia (VAP) protocol.

 Step 1

All ICU staff received education on heel ulcer prevention, skin assessment, and staging of ulcers. This education was provided via biannual skills fair, staff meetings, poster board, and bedside training of individual staff members.

 Step 2

The WOCN chose to implement the use of a heel boot (pre-inflated air boot with an opening at the heel). After 100% of the ICU staff had received training, nursing added the boot as a standard part of the VAP protocol. All ventilator dependent patients receive a complete skin assessment including risk assessment on admission to the ICU. Additionally, all ventilator patients have heel boots applied within 2 hours.

 Step 3

It was determined in the plan that data would be collected for one year. Nursing staff are to assess heels every shift and notify the WOCN if any skin breakdown is noted on the heels.

 Results

Data collection began April 1, 2007. As of November 1, 2007, there have been no facility acquired heel ulcers in the Intensive Care Unit.