Heels Held High: A Performance Improvement Project to Prevent Heel Ulcers in Hospitalized Patients

Heels Held High: A Performance Improvement Project to Prevent Heel Pressure Ulcers in Hospitalized Patients

Diane Holland RN, MS, CWON, Highland Hospital

Background: The heel is the second most common site for pressure ulcers accounting for 30% of all pressure ulcers¹. Patients with heel pressure ulcers (HPU) often have bad consequences from their wounds including: infection, amputation and death. In addition, the center for Medicaid and Medicare will no longer pay for cost related to hospital-acquired pressure ulcers².  Decreasing HPU involves identifying high risk patients and using interventions to eliminate pressure on the heel.

Objective:  To determine whether a HPU educational program for staff can reduce hospital-acquired HPU.

Method:   A midsize hospital in New York looked at best practices to prevent HPU and compared those to actual practice.  We identified units with the highest rates of HPU through our national database of nursing quality indicators (NDNQI).  A computer based educational program was implemented with topics including: identifying patients at risk, positioning, and  heel products available.  Posters with proper heel positioning were displayed. Results of NDNQI audits pre and post education were compared.

Results:  The standard hospital pillow used to “float” the heel often left heels on the bed.  Some patients had their heels in the center of the pillow not in the “floating” position.  Heel suspension boots were seldom used.

Results of the NDNQI pressure ulcer audits showed that before the program, the number of HPU ranged from 0 to 4.  Results since the program have shown no HPU.   

Discussion:  Keeping heels off the mattress is difficult for patients and pillows do not adequately elevate the heel. New pillows and heel suspension boots have been added. Careful heel positioning and frequent checks are needed to prevent heel breakdown.

The introduction of an educational program for HPU decreased the number of HPU in two units with high prevalence rates.  Calling attention to a problem and educating staff can promote better outcomes.  We hope to expand our program to other units