″Lifting Away″ Hospital Acquired Pressure Injuries on the Heel

Background

Heel injury (HI) is the most prevalent type of hospital-acquired pressure injury.  In addition, a study of 450,000 patients found that the heel accounted for 41% of deep tissue injury. Risk factors associated with the development of heel ulcers, include: agitation, diabetes, surgery, immobility, arterial insufficiency, age, and poor nutrition.  The most effective evidence-based practice (EBP) to prevent HI is the use of heel suspension to elevate and offload the heel.  Associated best practices include patient positioning to prevent both foot drop and maintain leg alignment.  In 2015 we experienced an increased incidence of HI. The goal our project was to implement EBP and decrease HI.

Methods

We developed an algorithm to identify patients at risk for HI and implemented it in 5 clinical units.  At-risk criteria included: non-ambulatory, Braden score of <15, and two or more co-morbid conditions. A boot designed to offload the heel, reduce plantar flexion, prevent lateral rotation and stay in place was used on patients who met the at-risk criteria.  All staff were educated on the new algorithm and compliance was tracked.

Results

In the 11 months prior to implementation, we had a monthly HI incidence of 1.8 (20 total). Since implementation, we have had 10 consecutive months without a HI.  Compliance with the new EBP in our highest risk patients (critical care and rehab) was 100%, with 80% and 50% in the 2 medical-surgical units (overall 82%).

Conclusion

The implementation of the algorithm was associated with a decrease in monthly HI incidence from 1.8 to 0.  In addition to avoidance of pain and suffering for patients impacted by HI, numerous data support that the overall cost of prevention is far less than the cost of treatment for hospital-acquired pressure injury.  Our plan is to continue with the new EBP and improve overall compliance.