Background: The National Pressure Ulcer Advisory Panel (NPIAP) defines a pressure injury as a localized injury to the skin and/or underlying tissue as a result of pressure or when soft tissue is compressed between a bony prominence and an external surface for a prolonged period of time (NPIAP 2018). In 2017, at LIJ Forest Hills, there were 41 hospital-acquired pressure injuries (HAPI) and 18 lower extremity hospital-acquired pressure injuries. The aim of the study is to find a way to reduce the number of hospital-acquired pressure injuries to the lower extremities/heels.

Methods: The age demographics were from 27-101, both genders included, and from all units (excluding emergency room and labor and delivery). Patients who are immobile, on bedrest, contracted, with a Braden scale below 19, and with impaired skin integrity were targeted. Heel protectors were put on PAR and stocked twice a day and in-services were given for appropriate use, with 2-RN validation and assessment on admission.

Results: 100% compliance for nursing in-service, decrease in total HAPI from 41 (2017) to 5 (2020), and no heel/lower extremity hospital-acquired pressure injury in the past 3 years

Education: Education for this initiative started June 2017 and continues to this day. This was spearheaded by the CWOCN and supported by nursing education and nurse managers for each individual unit. The “no heel HAPI” in-servicing consisted of using the Posey heel boots or standard pillows for offloading, identifying patients that are in need for heel offloading (Braden scale score less than 17, bedrest, poor nutrition, altered mental status), educating the patient/family in regards to the need for heel offloading, and documenting these interventions and education provided.

Each unit received morning (night-and day-shift) and afternoon (mid-shift) in-servicing. Evaluation of the effectiveness of the in-servicing was done on daily rounds for each unit by the unit nurse manager and/or the CWOCN. Evaluation of the effectiveness of the initiative is done daily when the CWOCN receives the daily reports on HAPIs and pressure injuries present on admission. Evaluation is also done weekly due to weekly prevalence studies done by the CWOCN and the nurses on the units.

Conclusion: At the beginning of each year, the goal is to see a 25% reduction in the amount of heel/lower extremity hospital-acquired pressure injuries. Upon implementation of all of these interventions, we were able to see a complete decrease of hospital-acquired heel/lower extremity pressure injuries to ZERO for the past 3 years. The major indicator of compliance with the initiative and effectiveness of the education is application of the pressure injury prevention resources (heel boots or pillows) for all applicable patients and reduction of heel/lower extremity hospital-acquired pressure injuries.

Learning Outcome: After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.

Frantz Dorestant MSN, RN, CWOCN

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