Prevalon Custom Clinical Practice Assessment Forms

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Clinical Practice Assessment

Incorporating a heel pressure ulcer prevention protocol—combined with early, aggressive implementation of pressure-reducing and pressure-relieving devices—has been proven to reduce the rate of heel pressure ulcers.¹ Before measuring progress, however, it is important to assess the current state of heel care and protection at your facility, including current interventions and caregiver knowledge. To create your custom Clinical Practice Assessment form, start by entering the following information:

Your Name:		Click here to print a full list of questions. Click here to print a sample of a finished form.
Facility Name:
Unit:
Return Form To:

Next, check the boxes next to the questions you would like to have printed on the form. A maximum of 10 questions can be selected. When finished, click "Next Step."

I am familiar with my facility's heel protection protocol.

I am familiar with key risk factors associated with heel breakdown.

I know the risk factors for developing facility-acquired heel ulcers.

I know how to identify heel pressure ulcers.

I know how to prevent heel pressure ulcers.

I can recognize changes in the skin that signal risk of skin breakdown.

I know how quickly heel damage can occur.

I know heel breakdown can occur often in patients with the least risk range (18-15 on Braden Scale).

Frequent skin assessment, using a tool such as the Braden Scale, is very important.

Skin assessments are performed frequently at my facility using a tool such as the Braden Scale.

On my unit, patients' heels are assessed routinely and adequately assessed using a tool such as the Braden Scale.

I know my unit's heel pressure ulcer prevalence/incidence rates.

It is important to use heel protection devices on patients for treatment.

It is important to use heel protection devices on patients for prevention.

I use heel protection devices on my patients for treatment.

My unit uses heel protection devices for treatment.

I use heel protection devices on my patients for prevention.

The heel protection device my facility currently uses totally relieves heel pressure.

The heel protection device my facility currently uses adequately prevents foot drop.

The heel protection device my facility currently uses stays on and in proper position.

The heel protection device my facility currently uses is compatible with deep vein thrombosis (DVT) compression devices.

The heel protection device my facility currently uses is comfortable for my patients.

The heel protection device my facility currently uses is easy to put on and remove.

I see compliance issues with existing heel pressure relief methods or devices.

Pillows are frequently moved after being placed for pressure relief.

It is not easy to keep pillows properly positioned to relieve heel pressure.

I know the difference between pressure reduction and pressure relief.

My patients need improved heel protection methods and/or products.

There must be an easier/better way to protect my patients heels.

My unit is targeting a reduction of facility-acquired heel ulcers.

1. Walsh J, et al., Keeping heels intact: evaluation of a protocol for prevention of facility-acquired heel pressure ulcers. Presented at the Symposium on Advanced Wound Care (SAWC), San Antonio, TX. Apr. 2006.

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