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Heel Pressure Ulcers Prevalence, Cost, Etiology and Risk Factors

Heel Pressure Ulcers Prevalence, Cost, Etiology and Risk Factors. The Problem:. HEEL PRESSURE ULCERS. Occiput. 2. Heel 30.3%. Scapula. 3 . Ischium (sit bone) 8.0%. Elbow. 4. Elbow 6.9%. Trochanter. Sacrum. 5. Malleolus (ankle bone) 6.1%. Ischium.

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Heel Pressure Ulcers Prevalence, Cost, Etiology and Risk Factors

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  1. Heel Pressure UlcersPrevalence, Cost, Etiology and Risk Factors

  2. The Problem: HEEL PRESSURE ULCERS

  3. Occiput 2. Heel 30.3% Scapula 3. Ischium (sit bone) 8.0% Elbow 4. Elbow 6.9% Trochanter Sacrum 5. Malleolus (ankle bone) 6.1% Ischium 6. Trochanter (hip bone) 5.1% Knee 7. Knee 3.0% 9. Occiput (back of head) 1.3% Malleolus Heel Anatomic Locations of Pressure Ulcers • Sacrum 36.9% 30.3%Heels 8. Scapula (shoulder blade) 2.4% • Amlung SR, Miller WL, Bosley LM, Adv Skin Wound Care. 2001 Nov/Dec;14(6):297-301.

  4. Epidemiology of pressure ulcers • However, heels are highest incident ulcers! • Incident (facility acquired) • 26.1% of acute care ulcers • 23.6% of LTAC ulcers • 24.5% of LTC ulcers © Black 2011 Data from VanGilder (2008), N = 85,838

  5. Heel ulcers • Cost to manage a pressure ulcer can range from $2,000 - $30,000 for stage I, II, or III and up to $70,000 for a full thickness pressure ulcer • Extrapolating from the CMS data, approximately $3.3 billion associated with hospital-acquired heel ulcers (2007 data) • CMS declared many heel ulcers “Never Events”3. (reasonably preventable errors in healthcare) 1.Cuddigan J, et al. Pressure Ulcers in America: Prevalence, Incidence, and Implications for the Future. National Pressure Ulcer Advisory Panel, Reston, VA.2001 2.Hunt DR, et al.(2005). Fundamentals of Medicare patient safety surveillance: Intent, relevance, and transparency. Centers for Medicare and Medicaid Services, Baltimore, MD.2005 3.Centers for Medicare and Medicaid Services.. 2008

  6. Risk Factors for Heel Ulcers • Anatomical prominence of calcaneus • Lack of fat pad • Leg immobility • Ask the patient if he can lift his leg from the bed • Diseases that impair sensation • Stroke, MS, Diabetes, Paralysis • Diseases that impair perfusion • Arterial inflow disease © Black 2011

  7. Best Practice Recommendations for hPU Prevention • Off-load the heel • NPUAP 2009 • AHRQ 1992 • Maintain grip of the limb • Salcido et al. 2011. Advances in Skin & Wound • Lyder 2011. WCET • Lyder 2010. IHI • Prevents Plantar Flexion Contracture and Lateral Rotation • Salcido et al. 2011. Advances in Skin & Wound. • Black. 2004. Nursing. • WOCN 2010. Pillows do not prevent against foot drop and lateral rotation of the leg.

  8. Product demonstration

  9. Level of Evidence Pyramid Systematic Reviews and Meta-analyses Randomized Controlled Double Blind Studies 4 Peer Reviewed Publications: - Walsh (JWOCN 2007)- Lyman (JWOCN 2009)- Meyers (JWOCN 2010) - Fowler (OWM 2008) Case Control Studies Over 25 posters presented atInternational clinical conferences Case Reports Adapted from Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine what it is and what it isn’t. BMJ. 1996;312(7023):71-2

  10. Jill WalshPublished March 2007 JWOCN Objective:To identify risk factors (Braden score and co-morbidities) Study Method:Two year Retrospective chart review of patients admitted with or developed heel ulcers. Pts. on HU Prevention protocol for 10 days. Braden + co-morbidity. Compared Prevalon to Waffle-boot Results:53 patients. 0 Heel Ulcers. 8 hip fractures. Prevalon preferred: comfort, warmth, heel protection, DVT compression compatibility. Conclusion:Heel Ulcer prevention protocol (Braden’s 16-18 and co-morbidities) and the use of a pressure-relieving device is effective in reducing the rate of heel pressure ulcers. Prevalon outperformed the ‘control’ product (p>.05; stat. sign.)

  11. Vicki LymanPublished December 2009 JWOCN 550 beds 87 heel ulcers in 2005 “Nothing works, I’ve tried everything.” Jill Walsh Protocol (18 Braden’s and co-morbidities) 5/05-9/05 = 39 heel ulcers compared to 5/06 – 9/06 = 2 heel ulcers 95% reduction Objective: Assess impact of Protocol and new Heel Device (18 Bradens and co-morbidities) Results: 39 PUs reduced to 2 PUs over same time period (95% reduction) Estimated ROI of $12,000-$1.4MM

  12. Tina Meyers BSN, RN, CWOCN, ACHRNPublished August 2010 JWOCN Title: Successful Prevention or Heel Ulcers and Plantar Flexion Contractures in High Risk Ventilator Population Objective: Targeted reduction of heel injury and plantar flexion contractures in the sedated, ICU patient (Ventilator for 5 days and Braden’s <16) Intervention: Use of heel protector with contracture strapon 53 high risk patients – 7 months Results: 0 PF contractures; 0 Heel Ulcers; 5 patients with abnormal ankle ROM improved; Revenue Preservation of $1.9MM Conclusion: New Heel Protector with Contracture Strap effectively reduced the risk of heel ulcers and PF contractures in 53 patients Presented at World Union of Wound Healing Society Meeting in Toronto, May 2008

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