Make a difference: standardize your heel care practice

The effective prevention and treatment of pressure ulcers has always been an essential nursing concern. Many advances, such as pressure reduction beds, have greatly reduced the incidence of ulcer development. In an urban teaching hospital the incidence of sacral ulcers decreased upon initiation of pressure reduction surfaces, while a concomitant increase in heel ulcers was noted. Heel ulcer prevention had not previously been singled out as a specific area of focus in skin pressure ulcer prevention. Given the increased incidence of occurrence of heel pressure ulcers in this institution's patient population, a multidisciplinary team met to address the issue of heel ulcer prevention. A quick, easy and user-friendly risk stratification tool was developed and guidelines for care of the at-risk patient were implemented. Initiation of the heel pressure ulcer identification tool and guidelines resulted in a decrease of heel pressure ulcer prevalence in the medical intensive care unit patient population.