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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 growing advances in healthcare, pressure ulcers are a bigger problem than ever. So big, in fact, that starting in October 2008, the Centers for Medicare and Medicaid Services (CMS) will no longer reimburse hospitals for pressure ulcers not present upon admission.3 Still, HAPU's are "largely preventable."4 |
CMS Getting Tough
If it's not POA, they won't pay!
Starting on October 1, 2008 the Centers for Medicare and Medicaid Services (CMS) will no longer reimburse hospitals for pressure ulcers not present upon admission.3
IHI Five Million Lives Campaign
Prevent Pressure Ulcers10
6. Minimize Pressure
"Relieving pressure, especially over bony prominences, is of primary concern. Patients with limited mobility are especially at risk for the development of pressure ulcers. Every effort should be made to redistribute the pressure on the skin, either by repositioning or by utilizing pressure-relieving surfaces."10
"….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)."10
Prevalon is a simple and low-cost intervention that can help facilities meet these patient safety initiatives.
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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. |
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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 |
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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 |
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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 |
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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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| References: 1. Amlung SR, Miller WL, Bosley LM, Adv Skin Wound Care. Nov/Dec 2001;14(6):297-301. 2. Walsh J, DeCampo M, Waggoner D, Keeping heels intact: evaluation of a protocol for prevention of facility-acquired heel pressure ulcers. Poster presented at the Symposium on advanced Wound Care, San Antonio, TX, Apr 2006. 3. Federal Register, Vol. 72 No.162, 2007 Aug: 47201-47205. 4. Beckrich K, Aronovitch SA, Nursing Economic. Sep/Oct 1999;17(5):263-71. 5. Maklebust J, Magnan MA, Adv Wound Care. Nov 1994;7(6):25, 27-8, 31-4 passim. 6. Levin M, Adv Wound Care. Mar/Apr 1997;10(2):24-30. 7. Wong VK, Stotts NA, JWOCN. Jul 2003; 30(4): 191-8. 8. Folkedahl BA, Frantz R, Prevention of pressure ulcers. Iowa City (IA) University of Iowa Gerontological Nursing Interventions Research Center, Research Dissemination Core; May 2002. 9. Young ZF, Evans A, Davis J, J Nurs Admin (JONA). Jul/Aug 2003;33(7/8):380-3. 10. Getting started kit: prevent pressure ulcers: how-to guide. Protecting 5 million lives from harm campaign, Institute for Healthcare Improvement (IHI), 2006. 11. Coats-Bennet U, Critical Care Nursing Quarterly. May 2002;25(1):22-32. 12. Burda V, A successful heel ulcer prevention program resulting in 95% reduction of heel ulcer incidence. Poster presented at the Symposium on Advanced Wound Care, Tampa, FL, Apr 2007. 13. Meyers T, et al., Successful prevention of heel pressure ulcers and foot drop in the high risk ventilation patient population. Poster presented at Institute for Healthcare Improvement (IHI), Orlando, FL, Dec 2007. 14. Brainard N, Ortiz L, Simple low cost intervention saves VA hospital thousands through reduction in heel injury. Poster presented at Institute for Healthcare Improvement (IHI), Orlando, FL, December 2007 15. Garrett D, Intervention with a new heel protection device and silver alginate dressing to prevent amputation of lower leg due to stage IV ulcer of the heel and malleolus. Case study conducted at Salem Village Nursing and Rehabilitation Center, Joliet IL, Oct 2006. |
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