Poster presented at the 21st Annual Symposium on Advanced Wound Care and The Wound Healing Society Meeting : April 24-27, 2008

Head Over Heels: Best Practices for Preventing Heel UlcersEvonne Fowler, RN, CNS, CWON and Suzy Scott, RN, MSN, CWOCN

Is Patient at Risk for Heel Pressure Injury?

� Follow nursing guidelines for routine skin care.

� Ensure adequate position changes.

YES

� Educate patient on pressure reducing techniques.

� Establish patient appropriateness.

Patient MUST:1 Have the potential to be AMBULATORY2 Be AMBULATORY2 Be recommended for off-loading heel with

gait/mobility4 Referral to Physical Therapy

� Review criteria for pressure-relieving heelprotector

� Establish patient appropriateness.

Patient MUST:1 Be NON-AMBULATORY2 Have a total Braden Score of 15 or less3 Have TWO or more co-morbidities

- Determine “Can the patient lift his/her leg?”- If patient does not meet the above criteria but

the nurse has concerns about heel protectioncall for a wound care consult to assess.

NO

� Follow nursing guidelines for routine skin care.

� Ensure adequate position changes.

� Institute “Pressure Ulcer Prevention – Skin Care Preventions”:- Elevate heels off bed- Reposition every 2 hours- Assess skin integrity every shift

Is Patient Ambulatory?YES NO

Decision ttree*

* Developed by Christine Baker, RN, MSN, CWOCN, APN.

RReeffeerreenncceess::

1 Centers for Medicare & Medicaid Services. Changes to the Hospital Inpatient Prospective Payment Systems andFiscal Year 2008 Rates. Federal Register. 2007;27:73,77.

2 NPUAP. Pressure Ulcer Stages Revised by NPUAP. Available at: www.npuap.org/pr2.htm. Accessed on: April 16, 2008.

3 Amlung SR, Miller WI, Bosley LM. The 1999 National Pressure Ulcer Prevalence Survey: a benchmarking approach.Adv Skin Wound Care. 2001;14:297-301

4 Walsh J, et al., Keeping Heels Intact: Using a Nursing Professional Practice Model Can Improve Outcomes. Advancefor Nurses. 2006;8:25.

5 Makelbust JA, Magnan MA. Risk Factors Associated with Having a Pressure Ulcer: A Secondary Data Analysis. AdvWound Care. 1994;7:25-42.

6 Walsh J, et al., Keeping Heels Intact: Evaluation Of A Protocol For Prevention Of Facility-Acquired Heel PressureUlcers. Adventist Hinsdale Hospital, IL. Poster presented at the Symposium on Advanced Wound Care, San Antonio,TX. April, 2006.

7 AORN. Aorn Standards Recommended Practices & Guidelines 2007 (Publisher-Assoc. Operating Room Nurses (Jun15 2007).

8 Scott-Williams S, Lummus AC. Perioperative pressure ulcer assessment and prevention: Efficacy study of a multi-layer pressure relief pad in the operating room. Poster presented at: Annual Symposium on Advanced Wound Care(SAWC), Tampa, FL, April 2007.