Preventing Heel Pressure Ulcers in Acute Care

Topic: Preventing Heel Pressure Ulcers in Acute Care.

Purpose: Bedside GEMBA audits of 37 inpatients with a Braden score of  ≤ 18 were performed to identify the current state of nursing skin assessment and interventions of patients at risk of heel pressure ulcers in a hospital setting. The results revealed a lack of standardized process and nursing education related to heel assessment and proper interventions for preventing heel pressure ulcers. Heels were being assessed during skin assessment 27% of the time. Approved heel offloading devices were in place 39% of the time when indicated.

Objective: Decrease heel ulcers by 50% in the third quarter of 2010 by educating nurses on performing thorough heel assessments and use of appropriate heel offloading devices. A heel campaign initiated by a multidisciplinary team using various methods was instituted to educate nursing staff prior to 7/1/2010. Education was performed through PowerPoint presentations at staff meetings. 1:1 bedside clinician education was performed during audits. Each nurse was given a mirror to perform visual heel assessments. To aid nurses in remembering all of the steps, the mnemonic R.A.I.S.E was created and placed on posters throughout the hospital and on laminated cards placed at the foot of all patient bed frames.

Remove all foot coverings

Assess all aspects of the heel (tactile and visual)

Institute appropriate interventions

Save Skin

Evaluate Effectiveness

Outcomes: Zero hospital acquired heel pressure ulcers were reported in the third quarter of 2010. Post- campaign bedside GEMBA audits were performed on 39 inpatients after 10/1/2010 to evaluate nursing retention of education. These audits revealed a marked increase of heel assessments and appropriate use of heel offloading devices in patients at risk of developing heel pressure ulcers. Heel assessments increased to 92%. Use of approved heel offloading devices increased to 77% when indicated.