The heel and ankle bone are the second and fifth most common sites for pressure ulcer development.1 One study finds 43% of hospital-acquired pressure ulcers (HAPUs) developed on the heel.2 Despite advances in healthcare, pressure ulcers are a bigger problem than ever. So big, in fact, that the Centers for Medicare and Medicaid Services (CMS) no longer reimburses hospitals for pressure ulcers not present on admission.3 Still, HAPUs are "largely preventable. "4
Risk Factors for Heel Pressure Ulcers
Impaired mobility
Of the risk factors occurring in patients who develop pressure ulcers, impaired mobility is the most frequent at 87%.5 Over half also suffer from malnutrition and decreased mental status.
Diabetes
Diabetic patients confined to a bed often keep their heels in the same position due to the loss of sensation. These patients also suffer friction trauma when the patient uses the heel to change body position. These two processes can lead to skin breakdown.6
Surgery
Lying immobile in pre-surgery, during the procedure, and post-op recovery adds up to several hours without proper heel protection. One study shows surgeries greater than three hours accounted for almost 25% of HAPUs, plus 30% to 40% of the total costs.4
Various other conditions
Other risk factors include peripheral vascular disease, metastatic cancer and spinal cord injury.5 While external pressure causes decreased blood flow, it can also result from arteriole disease, diabetes, circulatory problems, decreased hyperemic response and age.7
Enormous Hospital Costs
The annual cost of treating HAPUs is a staggering $2.2 to $3.6 billion.4 Costs increase with wound stage, ranging "...from $2,000 to $30,000 for stage 1,2, or 3 ulcers to $70,000 for a complex, full-thickness stage 4 ulcer."9
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CMS Getting Tough
If it's not POA, they won't pay!
The Centers for Medicare and Medicaid Services (CMS) no longer reimburses hospitals for pressure ulcers not present on admission.3
Best Practices for Preventing Heel Pressure Ulcers
Assocciation of Perioperative registered Nurses (AORN)
In its recommended practices and guidelines, AORN recommends, among other interventions, that facilities "use devices that eliminate or redistribute pressure" to prevent perioperative* heel ulcers.11
IHI Five Million Lives Campaign
Prevent Pressure Ulcers10
6. Minimize Pressure
"... Use pillows under the calf to elevate the patient's heels off the bed surface. Place cushioning devices between the legs/ankles to maintain alignment and prevent pressure on bony prominences. (NPUAP clinical guidelines, 1992)."
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