Prevention of heel pressure ulcer among adult patients in orthopaedic wards: An evidence-based implementation project




Poster session 4 Saturday: Evidence implementation and evaluation


Saturday 16 September 2017 - 12:30 to 14:00


All authors in correct order:

Koh SY1, Yeo HL1, Thiara EK1, Goh ML1
1 Singapore National University Hospital (NUH) Centre for Evidence-Based Nursing: A Joanna Briggs Institute Centre of Excellence, Singapore
Presenting author and contact person

Presenting author:

Siew Yi Koh

Contact person:

Abstract text
Background:Immobility and prolonged bed rest often lead to heel pressure ulcer (HPU) in patients. Evidence suggests that offloading heel with relieving devices aids decrease the occurrence of hospital acquired pressure ulcer. A point prevalence audit undertaken in orthopaedic wards of a Singapore tertiary hospital reported that 20% (6 out of 30) of patients with impaired mobility have mild to blanchable redness on their heels. The results reported inconsistency in nurses initiating heel-offloading techniques and documenting this nursing intervention.

Objectives:The evidence-based project sought to achieve 80% compliance of nurses to practice heel-offloading practice and 50% reduction in HPU occurrence.

Methods:The project was undertaken in two orthopaedic wards. A pre and post-implementation audit strategy, with the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice programmes was utilised. The implementation occurred over 17 months, from March 2015 to July 2016 (Table 1). All nurses were briefed to offload the affected lower limbs using heel foam protector and a towel or pillow. These were shared through daily roll-calls using a pictorial guide (Figure 1). A sample size of 30 patients with impaired mobility according to the Braden Scale was audited via consecutive sampling.

Results:There was an increased in nurses’ compliance in performing the heel-offloading techniques when compared to the pre-implementation audit, at follow-up audit 2 (20.0% vs. 76.7%). Nurses had consistent documentation of heel offload (63.3%).The post-implementation audit showed 83.3% compliance on nurses performing heel offloading techniques in the subsequent two follow-up audits. The incidences of HPU development decreased from 6 to 3, a 50% reduction since the initiation of the project (Table 1).

Conclusions:The implementation of the heel offloading significantly reduced the incidence of HPU in the orthopaedic wards. It is essential to equip the nurses with knowledge on heel offloading and its implications while reducing the incidences of HPU