Evidence-Based Practice
Heels are extremely vulnerable and frequently the site of pressure injuries. The heel is made up of adipose tissue and thick elastic muscle fibers/plantar fascia. When a patient is in bed the heels rest directly on the surface absorbing the weight of the leg increasing the risk of heel pressure injuries. Intensive Care Unit (ICU) patients are particularly vulnerable to heel injury from pressure due to their physiologic status and possible use of vasopressors which restrict blood flow to the peripheral limbs. General practice is to off-load heels with pillows.
Methods: An action research study was conducted to determine the extent of pressure injury prevention measures for heels on patient’s in the ICU. The use of Ishikawa/fish-bone assessment, literature review, evidence-based practice (EBP) per Wound, Ostomy, Continence Nurses Society guidelines 1 (WOCNS, 2016) was used to decrease heel pressure injuries. Interventions involved: staff education, product availability, protocol development, electronic medical record prompts, application of heel foam border and heel off-loading.
Results:
During the study interval (October 2022–February 2023) the number of monthly heel pressure injuries went from eight to zero. Using the bordered foam dressing and concomitant heel off-loading, compliance went from 14.2% (September 2022) to 84% (January 2023). Through product access; staff education and protocol implementation this intervention resulted in a significant decrease in heel pressure injuries.
Discussion:
Having an intervention available that redistributes pressure on the heels and prevents friction from effecting the skin, ICU RNs may be more likely to use the product. Products that redistribute pressure while also allowing for increased mobility can be more effective in overall pressure injury prevention.