Purpose:  To examine the factors influencing the development of foot and leg pressure ulcers (PrU) in the hip, knee, and fractured hip population.  After a pilot study of 10 patients we discovered barriers to a single component:  correct fit of anti-embolism compression (ACE) hose.  This poster illustrates process improvement to obtain correct fit which may influence PrU development.

Objective:  Reduce barriers to optimal fit of ACE hose.

Method:  All hip, knee, and fractured hip patients were examined post-operatively for pressure areas, size of calf and leg, and size of hose in use.  The correct size was replaced on any pt wearing an incorrect size.  All were on pressure redistribution surfaces upon admission.

Results: 39% of 23 patients were found to have an incorrect size in place.  Twenty-six  (26) % developed pressure areas that may be influenced by incorrect fit of hose.

Discussion:  Many factors may influence development of PrU.  Among these are age, nutrition, comorbidities, immobility, pain, support surface, and correctly fitting hose.  Data collection of first 10 patients suggested that other factors could not be examined until optimal fit of ACE hose was accomplished. 

Factors leading to correct fit are:

• Correct measurement of both legs
• Full range of sizes available at initial point of contact and at points where hose may be replaced
• Remeasurement when swelling or edema changes the size of the leg.

These barriers were addressed:

• Measuring tapes of correct length placed in the units
• Size range expanded to stock the missing sizes
• Size charts requested from the manufacturer
• Electronic requisition edited to clearly state the sizes and measurement of hose being ordered
• Education regarding importance of correct fit.

Conclusion:  System factors must be examined and corrected to facilitate delivery of the right care to every patient, every time.