Comparison between two heel off loading devices in Pressure Injury Prevention

Background:  Pressure ulcer prevention has become an essential role of the CWOCN, especially since the Centers for Medicare and Medicaid Services (CMS) began holding acute care hospitals accountable for hospital acquired Stage 3 and Stage 4 Pressure injuries.  We are to utilize evidence based practice and remain fiscally responsible.  While utilizing a venous thrombosis embolism sleeve, pressure injuries were developing along the Achilles and heel area of our critically ill patients wearing a plastic frame podus boot, resulting in device related pressure injuries.  After trialing two heel suspension boots recently introduced to the market, we chose the newest product, a soft upholstered heel off-loading boot (soft boot).  We needed to ensure we had an effective tool to reduce our incidence of heel pressure injuries.  Purpose and Methods:  The purpose of this study was to compare the effectiveness of two types of medical heel off-loading devices in preventing hospital acquired pressure injuries (HAPI) to the heel and foot.  A retrospective comparison study was designed to evaluate the two different heel offloading devices and the incidence of heel/foot HAPI in the facility. An IRB was obtained, protocol number 27149 and data was collected for 4 month periods over three years: 2014, 2015 and 2016. Medical records of 2,872 patients were reviewed for heel/foot HAPI.  Patients identified with heel/foot pressure injuries had additional information collected including Braden score, gender, age and stage of wound. Using statistical software, the one and two sided Fisher’s exact test was completed. Patient populations and acuity of illness were similar between the groups.  Results: The statistical analysis found the soft boot heel/foot HAPI rate was significantly lower, a ten-fold lower incidence rate than the podus type boot.  The effectiveness of newer products requires validation.