Without proper perioperative care, surgical patients are at higher risk for developing heel pressure ulcers (hPUs), and resulting infections are having substantial economic impact on the cost of care. According to a study presented at the AORN Annual Congress March 14 - 19, a heel pressure ulcer protocol should be adopted to optimize care for high-risk patients, comply with new Centers for Medicare and Medicaid Services (CMS) guidelines and minimize costs.

The cost of perioperative acquired pressure ulcers is estimated at $170 to $340 per surgery. This means the average hospital over 100 beds will incur $265,000 to $525,000 per year in costs directly attributable to the development of operating room (OR) acquired pressure ulcers.¹ Researchers from two facilities partnered on a pilot study targeting the elimination of heel ulcers in the high-risk surgical patient.

"Heel ulcers start in the OR so early intervention is critical. Applying a heel protector upon patient arrival to the OR will enhance compliance with hPUs prevention protocol," said Suzy Scott, MSN, RN, WOCN and lead investigator of this study. In the preliminary patient population, the heel protector boot has been effective in preventing heel skin injury during and after surgery.

Patients in the operating room are sedated and immobile, putting them at a higher risk for the development of pressure ulcers. The heel is the second most prevalent site for a pressure ulcer, an injury associated with morbidity and mortality. Morbidity related to hPUs includes pain and depression, reduced mobility and possible amputation. Patients with pressure ulcers also require long-term treatment, occupying hospitals- much-needed bed space. Beyond significantly affecting patient outcomes, heel ulcers impact the hospital with associated wound treatment, litigation, and result in lost reimbursement from CMS due to avoidable heel pressure ulcers.

After assessing the preliminary results, Scott recommends a combination of perioperative nurse education and application of a heel protector that is compatible with sequential compression devices to ensure 100 percent patient compliance to this preventative intervention. The heel protector is designed to minimize pressure and friction on the heel, while acting as a stabilizer for the foot during surgery and postoperative care. The device being used in this study is the Prevalon® Pressure-Relieving Heel Protector, manufactured by Sage Products Inc.

Recent healthcare reform has put additional focus on pressure ulcer prevention. In the last year, CMS added pressure ulcers to their list of never events, errors on the hospitals behalf that should have never occurred. As a result, CMS stopped providing reimbursement for hospital-acquired pressure ulcers. The CMS guidelines, along with research, are further increasing awareness for a preventative approach to patient care.

"There is more research needed, and it is also clear that a compliance protocol is essential," Scott said. "Taking a preventative approach to heel pressure ulcers in the OR will not only improve patient outcomes, but also reduce the number of never events, resulting in significant cost-savings and revenue preservation for the facility."

References: 1. Beckrich K, Aronovitch SA. Hospital-acquired pressure ulcers: a comparison of costs in medical vs. surgical patients. Nurs Econ. 1999; 17: 263-271.