Standardized Heel Pressure Ulcer Prevention Program

Pressure ulcers remain a health problem affecting all populations. Data on the cost of a pressure ulcer is inconsistent and is dependent upon institutional resources. It has been reported that treating a pressure ulcer doubles the cost of preventing them¹.  Prevention of pressure ulcers is a multidisciplinary approach with strong efforts related to nursing care. Nurses are the front-line to preserve skin integrity. Addressing problematic areas more likely to develop breakdown will focus nursing efforts on those areas. According to the U.S. National Pressure Ulcer Advisory Panel (NDNQI), the heel was the second most common site of pressure ulcers ². Pressure ulcers are reduced when standardized prevention protocols are adopted³.

Internal data suggested further efforts were needed to address Braden scale compliance and heel hospital acquired pressure ulcers (HAPU). Heel HAPU rates ranged 15 to 32 percent (June 2007 to June 2008). A shared decision making committee collaborated to address heel pressure ulcer rates. This Skin Care Liaison Committee (SCLC) identified the need to develop a standardized prevention program.  Program included admission & daily Braden Scale risk assessment scoring on all patients.  Next, staff initiated EMR orders sets offering individualized treatment plan for low, moderate, high risk patients with a required heel field to select method to maintain heels off of bed.  In addition, new heel pressure relief protectors and heel pressure relief decision tree were instituted. Resource manuals were provided and individual house-wide education performed by SCLC.  Developed EMR reports to evaluate Braden Scale compliance and maintained quarterly pressure ulcer prevalence studies (NDNQI) to monitor outcomes.

Braden Scale compliance significantly increased and remained 100% eight quarters once mandated daily on all patients.  Since implementation of the standardized heel pressure ulcer prevention program, seven of past nine quarters had ZERO heel HAPU.