Clinical Facts

Consolidate and Standardize – The Value of Universal Prevention

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Prior to HeelAHip®, the patient must rely on nurses to continuously offload the heels. To that end, heel ulcers are the second most common location for pressure ulcers. Pressure injury is particularly prevalent in surgical patients. Pillows and heel boots can be cumbersome and heel boots may hyperextend the popliteal vein and lead to venous pooling. Pillows are challenging to place correctly, comfortably, and consistently using the traditional abductor.

This timeline of quality as detailed in a presentation to the National Pressure Ulcer Advisory Panel by William Padula, PhD shows that financial incentives that were instituted for preventable injuries during care drew attention to pressure injury prevention as a potential area to save money.

In an issue about pressure ulcers and their impact on patients that have received or will receive surgery, Susan Shoemake, BA and Kathleen Stoessel, RN, BSN, MS provide this table of the percentage of patients that experienced pressure ulcers as a result of different specialties of surgery they received. Elderlt Orthopedic surgery topped the charts with an incidence of 66%. That means of every 100 patients that received elderly orthopedic surgery, about 66 of them resulted in pressure ulcers!

Timeline

1986

AHCPR Guideline / US Department of Health and Human Services Clinical Practice Guideline 1992 number 3

VERSLUYEN documented a 66% increase of pressure ulcers in elderly patients admitted for femoral fracture1

2000

July / August – Orthopaedic Nursing – Preventing Heel Breakdown

Significant risk factors for development of heel breakdown include … especially hip pinning and hip replacement surgeries2

Gaff, Marilyn K.; Bryant, Janet; Beinlich, Nancy

2004

November – Nursing 2004 – Preventing Heel Pressure Ulcers

Joyce Black speaks on: Patients with immobile legs … such as fractured hips3

2007

March / April Journal of WOCN

91% of heel ulcers are related to hip fractures (or knee replacement)

Doughty, Dorothy

2008

October – OWM – Practice Recommendations for preventing…

13% of elective and 14.2% of hip fracture(s) developed heel ulcers4

Fowler, Evonne; Scott-Williams, Suzy; McGuire, James

2010

February, August – OWM – Heel Ulcer Incidence Following Orthopedic Surgery

Heel ulcer occurence was 17% and 41% were sDTI or unstagable ulcers … 100% developed in acute care5

Dr. Karen Campbell of Ontario, Canada

2011

December – Advances in Skin and Wound Care

Changes in Heel Skin Temperature Under Pressure in Hip Surgery Patients
… hyperemic response was present only in the nonoperative leg … keeping the heels off the bed surface at all time may avoid heel skin temperature changes and prevent tissue damage

Wong, V. PhD, RN; Stotts, N. EdD, RN, FAAN; Hopf, H. MD; Dowling, G. PhD, RN, FAAN; Froelicher, E. PhD, RN, FAAN

2014

Wounds International Journal – PReventing Pressure Ulcers in the Surgical Patient

Prevention begins before the surgery … and is imperative during recovery from anesthesia6

Black, Joyce; Fawcet, Debra; Scott, Susan

2015

July / August National Pressure Ulcer Advisory Panel

Heel-protection devices should elevate the heel completely (offload them) in such a way as to distribute the weight of the leg along the calf7

2016

January Outpatient Surgery – Reduce the Risk of Pressure Ulcers

It’s good risk management practice to document the precautions you have in place8

2017

January – plos.org – Predictive factors for pressure ulcers in an older adult hospitalized for hip fractures

516 of 1083 patients (47.6%) developed pressure ulcers without positioning device on the limb9

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