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Another study published in JWOCN demonstrated a 100% prevention of both heel pressure ulcers and plantar flexion contracture over a seven month period when using the heel protector device. 3
Forty patients will be randomised, 20 to receive Prevalon boots and 20 to receive the standard pressure ulcer prevention method used by the ward they are on, to be used whilst in bed. Patients will be assessed daily for 10 days and at each assessment their heels will be photographed using a high resolution digital camera. A blinded assessor will assess all of the photographs to determine whether pressure damage has occurred at the heels. Maintaining alignment [with a pillow] may be difficult if the patient moves. In addition, pillows do not prevent plantar flexion contracture or lateral leg and foot rotation.” 1 Under the Limited License, Licensee has the rights to use and display the Training Video internally to its employees. Licensee agrees that the Limited License excludes the following rights to: A cross-referral to the NICE guideline on antimicrobial stewardship: systems and processes for effective antimicrobial medicine use will be made from recommendations 1.4.21, 1.4.22, 1.5.18 and 1.5.19. If Dr. Sage anticipates that an inpatient is likely to have prolonged immobility, he will prescribe such protection prophylactically. If there is drainage from any wound, he has patients cleanse the area daily, apply a topical product such as Silvadene and use a light gauze and Kerlix dressing to cover the wound as necessary to absorb the drainage. He emphasizes the importance of offloading.
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A cross-referral to the NICE guideline on nutrition support for adults will be made from recommendation 1.4.5. In one study, implementation of a heel pressure injury prevention protocol that included Prevalon Heel Protector resulted in a 28% decrease in facility- acquired heel pressure injuries over a one-year period. Continued use of the Prevalon Heel Protector over four years coupled with in-depth education, continuous monitoring of compliance, and continual reporting of outcomes to ensure accountability, resulted in a cumulative 72% decrease in heel pressure injuries. 4 In one study, implementation of a heel pressure ulcer prevention protocol that included Prevalon Heel Protector resulted in a 28% decrease in facility- acquired heel pressure ulcers over a one-year period. Continued use of the Prevalon Heel Protector over four years, coupled with in-depth education, continuous monitoring of compliance, and continual reporting of outcomes to ensure accountability, resulted in a cumulative 72% decrease in heel pressure ulcers. 4
A stakeholder queried the use of the term 'confined' in the guideline introduction because it implies an inability to move rather than reduced mobility, or choosing not to mobilise. This term is used in the first paragraph of the introduction to describe people in whom pressure ulcers typically occur. However the second paragraph goes on to note that all patients are potentially at risk of developing a pressure ulcer, but they are more likely to occur in people who are seriously ill, have a neurological condition, impaired mobility, impaired nutrition, or poor posture or a deformity. Therefore the risk factors in the introduction are wider than patients confined to bed or a chair and cover many different at-risk groups. Dr. Sage evaluates the wound for signs of infection and evaluates the foot for signs of ischemia. If infection is present, he says debridement and/or antibiotics may be necessary, but he does not debride stable, non-infected blisters or eschars. When a new patient presents with what appears to be a pressure ulcer on the lower extremity, Dr. Wendelken proceeds with a vascular assessment that includes an ankle/brachial index, a neuropathy assessment that utilizes the Semmes Weinstein test, and an assessment of mobility and range of motion. Multiple guidelines recommend the use of a heel protection device that completely offloads the heel to help prevent the development of heel pressure ulcers. Prevalon® Heel Protectors are the number one brand of heel protection. They offer continuous heel offloading to protect your patients’ heels. Choose the optimal heel protector Calf Cradles completely elevate the heels and distribute pressure over the lower leg without creating undue pressure on the Achilles tendon A stakeholder drew attention to one of their products which prevents pressure ulcers in the operating theatre. The product is a high-specification foam mattress and is therefore covered by the recommendations for high-specification foam mattresses in the guideline. We found no evidence in the current surveillance review specifically concerning this product.
Stakeholders requested a definition of a high-specification foam mattress be added to the guideline. It was noted that the guideline examined evidence on a variety of different high-specification mattress types, and the guideline committee were therefore unable to be highly specific about the nature of mattresses and so used the term 'high-specification foam mattress' (which is also used by the NPUAP/EPUAP/PPPIA guideline). McGovern J, DiPerri J. Heel pressure ulcer prevention: a comparative effective evaluation. Presented at the 25th Annual Symposium on Advanced Wound Care Spring (SAWC Spring)/Wound Healing Society (WHS), April 19-22, 2012. Dr. Suzuki is the Medical Director of the Tower Wound Care Center at the Cedars-Sinai Medical Towers. He is also on the medical staff of the Cedars-Sinai Medical Center in Los Angeles, and is a Visiting Professor at the Tokyo Medical and Dental University in Tokyo. Integrated Anti-Rotation Wedge helps prevent lateral rotation, reducing risk of peroneal nerve damage
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