Sweep Them Off Their Feet: A study between soft heel off-loading boots and pillows in the Progressive Care Unit of an acute care hospital

Purpose: This three month unit specific study was to determine the effectiveness of a heel offloading soft boot with standard pillows in prevention of the second most prevalent ulcer, heel pressure ulcers.(1) Research has found pillows are easily flattened, moved or dislodged causing the heel to touch the bed surface resulting in ischemia to the calcaneus.(2) Method/Objective: Wound care staff led daily heel checks on the 32-bed Progressive Care Unit which included foot rubs, regardless of risk, with brief pressure ulcer prevention education to 565 patients. All primary care nurses and nursing assistants were given instruction for the placement of the boots and proper alignment of pillows to offload heels. Critical thinking was encouraged, the decision tree provided included evidence based Braden Scale (3) for level of risk as a guide, lanyards with instructions of use and NPUAP pressure ulcer stage descriptions, and mirrors were placed in every staff member packet. Outcome: Fifteen (15) patients used the boots (14 pair and one single boot for an amputee). Of the 15 patients, 13 (86%) declined to continue to wear the boots due to discomfort related to heaviness, heat, lateral foot pressure, and new pressure sites on areas of foot. Two patients (13%) continued to wear the boots with varied hours of wear until discharge. Conclusion: While sweeping patients off their feet resulted in not recommending the purchase of this boot hospital-wide, use of pillows for offloading continues to require constant rearranging to keep pressure off the heel. Further trialing of effective heel offloading products is needed for this population. The reported discomfort experienced warrants acknowledgment that these nurses focused on patient satisfaction.