Skin Action Plan for Heel Ulcers

Skin Action Plan for Heel Ulcers

We established a Skin Care Action Plan for Heel Ulcers to decrease our high nosocomial pressure ulcer scores.   We fashioned a simple question that patient or staff could answer to determine need for patient to be placed on Skin Action Plan.  We provided for ultimate buy-in of staff for ownership of the Action Plan.

To ensure evidence based practice identification of patients at risk for impaired skin integrity we increased our Braden Scale score to 18.  When the score was 18 or less, the new practice included a care plan with frequent patient turning.  A visual reminder was used by placing a laminated spinning top sticker on the patients’ door.  Staff education, increased skin rounds and frequent evaluation of our outcomes was our focus.  When a patient presented with any one of the following criteria: 1) unable to lift foot off of bed, 2) confined to bedrest, 3) frail and weak, 4) orthopedic patient or 4) using Buck’s Traction, static air boots were placed on that patient.

As a result our nosocomial pressure ulcer rates dropped from a high of 27.3% in 2003 to 0% in 2006.  Our 2007 prevalence showed one nosocomial heel ulcer, which we believe was actually a missed POA.  Performance improvement skin rounds were originally done daily, now are done every Thursday.  We changed our practice by inclusion of the amended Braden Scale.  Education of our staff was aided by posters and staff meetings.  We had continuous reinforcement along with evaluation of our success.  The goal of 0% heel ulcers was achieved in 3 years.  Our Action Plan rule is: “No matter what your age, if you cannot lift your foot off the bed on your own; you will be placed on the Action Plan for Heel Ulcers”.