"Happy Feet"- A Quality Initiative to Prevent Heel Deep Tissue Injuries in Post Operative Total Hip Surgical Procedures

“Happy Feet”- A Quality Initiative to: Prevent Deep Tissue Injury Heel Pressure Ulcers in Post Operative Total Hip Surgical Procedures

 A Deep Tissue Injury (DTI) is defined as a purple or maroon localized area of discolored intact skin, or blood filled blister due to damage of underlying soft tissue from pressure or shear (1). The incidence of heel DTI pressure ulcers account for 30.3% of total hospital acquired pressure ulcers and is the second most common site for skin breakdown. (2) Several incidences of hospital acquired DTI heel pressure ulcers occurred in succession over a few months in this acute care facility in patients who had undergone total hip replacement surgical procedures.  The Shared Governance Council and Pressure Ulcer Prevention team realized the opportunity to impact patient outcomes by preventing the incidence of heel DTI pressure ulcers.  A quality initiative project was formulated using the PLAN, DO, STUDY, and ACT model to quickly improve outcomes and enhance patient safety in this population. Retrospectively, the incidences of hospital acquired DTI pressure ulcers were reviewed to determine common risk factors. A multidisciplinary action team developed a plan that focused on staff education and application of evidence based prevention measures. The initiative was entitled “Happy Feet” and proved to be a fun, innovative way to heighten awareness throughout the hospital. The success of the initiative was realized when the rate of DTI heel pressure ulcers decreased from a 4% incidence to 0% incidence within 12 months. Furthermore, since November 2010, not a single patient at this facility who underwent a hip replacement suffered a hospital acquired heel DTI.