.png)
Evidence-Based Practice
A review of heel hospital-acquired pressure injury (HAPI) occurrences among patients in the 32-bed medical-surgical orthopedic unit was done for the year 2020 and resulted in 11 patients with heel HAPI. A concept map is used to evaluate the causes of the injury and concludes that an average of 35 hours for lack of heel elevation and 28 hours without using a heel offloading device contributes to the injury in each patient admission.
Methods:
A quality improvement (QIP) project is implemented to prevent heel HAPI in the unit. The SAFE Heel protocol is made up of standard nursing interventions that are combined in a care bundle, can be integrated to nursing workflow and when done consistently will prevent heel HAPI. The protocol stands for: S for surgical/orthopedic patients, A is for heel assessment, F is for foam heel dressing and E is for elevation. The foam heel dressing is introduced as a standard offloading device to provide heel offloading or cushioning when total elevation is not possible due to restriction from the orthopedic surgery.
Results:
The QIP is implemented for 8 weeks, applied to all types of orthopedic patients, and did not result to any heel HAPI. Noncompliance for use of a standard heel offloading device and heel elevation was reduced to 6.5 and 8.3 hours respectively for all the 102 patients that are included in the QIP. The fitted regression model also concluded that heel skin assessment (β = 2.10, p = .01, 95% CI [.58, 3.63] and use of foam heel dressing (β = 0.97, p < .00, 95% CI [.78 1.16]) predict consistent elevation of heels preventing heel HAPI.
Discussion:
The SAFE heel protocol prevents heel HAPI and is approached as a care bundle providing nurses a standardized method of interventions that is integrated to their work and confirmed to improve patients’ outcomes. Since the protocol is validated through QIP, other units with the same challenges of pressure injury prevention can apply the protocol and customize it based on their patient population, average care acuities, nursing staff and unit environment.
Trademarked Items:
References: