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Evaluation of a Protocol for Prevention of Facility-Acquired Heel Pressure Ulcers

Walsh, Jill S.; Plonczynski, Donna J.

Section Editor(s): Doughty, Dorothy MN, RN, FNP, CWOCN, FAAN

Journal of Wound, Ostomy and Continence Nursing: March-April 2007 - Volume 34 - Issue 2 - p 178–183
doi: 10.1097/01.WON.0000264832.33979.4e
Special Focus: Pressure Ulcers: WOUND CARE

Objective We sought to determine whether identification of comorbidities (in addition to daily Braden scale assessment and early aggressive pressure reduction interventions) would impact the development of facility-acquired pressure ulcers (FAPU) of the heel.

Methods Patients admitted to a 333-bed community hospital located 20 miles west of Chicago. Overall, 70 medical records were reviewed, while 242 adult patients (46 in the intervention groups and 196 in the control groups) and 24 nurses participated in the study. The study was conducted in 4 phases, including a retrospective chart audit, 2 prospective interventions, and a product evaluation. Phase 1 entailed a retrospective chart review of patients who were admitted with or developed heel pressure ulcers over a 2-year period to identify factors most predictive of skin breakdowns. Phase 2 included two 10-day aggressive assessment and tailored intervention periods. Phase 3 involved prevalence day assessments of effectiveness of interventions as compared to patients on control nursing units. Phase 4 involved a staff survey comparing effectiveness and satisfaction of the current and trial heel pressure-relieving products.

Findings Risk factors for development of heel ulcers during hospital stay or prior to admission included type 2 diabetes mellitus (T2DM), peripheral vascular disease (PVD), low albumin, and Braden scale score. During implementation of phase 2 (two 10-day assessment and tailored intervention periods), no heel FAPU were associated with the intervention. During the phase 3 FAPU prevalence assessment, 3 patients had facility-acquired heel ulcers; 2 were in the control group and would have met inclusion criteria if included in the intervention. One patient was in the intervention group but was not following the protocol. During phase 4, there were significant preferences for the trial heel pressure relief device on effectiveness, as well as patient and staff satisfaction.

Conclusion A pressure ulcer prevention protocol that incorporated accurate assessment of risk factors (Braden Scale and comorbidities) with frequent documentation of heel skin integrity had a positive impact on the incidence of heel FAPU. In addition, early aggressive implementation of pressure-reducing and pressure-relieving devices was effective in reducing FAPU rates.

Jill S. Walsh, MS, RN, Clinical Nurse Specialist, Formerly Adventist Hinsdale Hospital, Hinsdale, IL.

Donna J. Plonczynski, PhD, RN, APN, Assistant Professor, Northern Illinois University, De Kalb.

Corresponding author: Jill S. Walsh, MS, RN (e-mail:

Copyright © 2007 by the Wound, Ostomy and Continence Nurses Society