2.50
Hdl Handle:
http://hdl.handle.net/10755/153893
Type:
Presentation
Title:
Outcomes from a Heel Pressure Ulcer Prevention Program
Abstract:
Outcomes from a Heel Pressure Ulcer Prevention Program
Conference Sponsor:Sigma Theta Tau International
Conference Year:2002
Conference Date:July, 2002
Author:Gilcreast, Darlene
P.I. Institution Name:Brooke Army Medical Center
Title:Assistant Professor
Objective: Heels are the second most common sites for pressure ulcers in hospitalized patients, exceeded only by the coccyx. Eleven investigators reported incidences of pressure ulcers in acute care settings ranging from 7% to 38% for Stage I to IV. Costs of healing a pressure ulcer average $11,000. Research Questions for this study were: 1) What is the incidence of heel pressure ulcers in hospitalized acutely-ill patients? 2) Are there differences between subjects who do/do not develop heel pressure ulcers? 3) What are factors that predict who will/will not develop heel pressure ulcers? 4) Which of three devices is most cost effective in preventing pressure ulcers? 5) Do patient characteristics play a role in predicting clinical outcomes? Population: English-speaking hospital inpatients >18 years of age with Braden Score <15 (moderate to high-risk for heel pressure ulcers) were sampled. Sample: Sixty-nine percent of 242 enrolled subjects were ICU patients and fifty percent had impaired mental status. Mean age was 64 years (SD=20 years, range 18-97). Distribution of age was equivalent within device groups. Mean BMI of the sample was 26 (SD=6, range 19-33). Among groups, BMI was equivalent. Males were 58% of the sample. Minorities comprised 35% of the sample (Blacks 15%, Hispanics 16%, and other 4%). Setting: Two military hospitals in South Texas were the sites of the study. Years: The study took place from 1997 to 2001. Variables Studied Together: Patient age, gender, smoking status, diagnosis, co-morbidities, nursing unit, and bed surface were assessed. Intervention: Three common heel pressure-reduction devices used for pressure ulcer prevention were compared (polyester fleece bootie, polyurethane foam foot-prop positioner, and air-waffle boot) for effectiveness. Outcome Variables: Development of pressure ulcer Grade I-IV, length of stay at the time of pressure ulcer development, ulcer healing during stay, cost effectiveness of devices, and co-morbidities were measured. Methods: The study was a prospective, randomized, clinical intervention. Patients were recruited within 18 hours of identification of risk and randomly assigned to one of three devices. A certified wound-care nurse visited patients daily and reassessed Braden risk and skin outcomes. Findings: Analyses on 240 subjects show no statistically significant differences in effectiveness between devices. Twelve pressure ulcers developed in 240 subjects (incidence=5% at both hospitals). Three ulcers occurred in 77 subjects (3.9%) wearing polyester fleece heel protectors, four pressure ulcers developed in 87 subjects (4.6%) wearing the foam foot prop positioner, and five pressure ulcers occurred in 76 subjects (6.6%) wearing the air-filled waffle boots. We found that nursing staff placed pillows under the legs of subjects who were randomized to the polyester fleece bootie, even though we requested that they not do so. Thus, subjects assigned to the polyester fleece bootie received greater pressure relief than they would have received with the device alone. Polyester fleece booties cost $3.52 per pair or $271 to treat 77 subjects. However, it must be remembered that nursing staff supplemented these devices with pillows, which would have cost an additional $14 per pair or $1,349 to treat 77 subjects. Polyurethane foam foot prop positioners cost $29.50 per pair or $2,567 to treat 86 subjects. Air-waffle boots cost $76.00 per pair or $5,776 to treat 76 subjects. From this view, the polyester fleece bootie was the most cost-effective. Conclusions: Smokers and persons with existing pressure ulcers are two times as likely to develop heel ulcers as nonsmokers. Subjects with diabetes mellitus and cardiovascular disease were five times more likely to develop pressure ulcers. Nurses supplemented the polyester fleece bootie with pillows under the calves of the legs although they were asked to refrain from this practice. Therefore, independent nursing action remains a factor in who will/will not develop pressure ulcers. Subjects' compliance with wearing the devices was 85%. As subjects' level of consciousness increased, subjects were less likely to wear any device. Implications: Whether a patient has an existing pressure ulcer anywhere on the body, is a smoker, has diabetes or heart disease can cue nursing staff to monitor the skin of patients very closely for breakdown. Would pillows alone have been as effective as the polyester fleece booties plus pillows? Evidence is provided that pillows may be effective.

Repository Posting Date:
26-Oct-2011
Date of Publication:
Jul-2002
Sponsors:
Sigma Theta Tau International

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleOutcomes from a Heel Pressure Ulcer Prevention Programen_GB
dc.identifier.urihttp://hdl.handle.net/10755/153893-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Outcomes from a Heel Pressure Ulcer Prevention Program</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Sigma Theta Tau International</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2002</td></tr><tr class="item-conference-date"><td class="label">Conference Date:</td><td class="value">July, 2002</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Gilcreast, Darlene</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Brooke Army Medical Center</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Assistant Professor</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">gilcreast@uthscsa.edu</td></tr><tr><td colspan="2" class="item-abstract">Objective: Heels are the second most common sites for pressure ulcers in hospitalized patients, exceeded only by the coccyx. Eleven investigators reported incidences of pressure ulcers in acute care settings ranging from 7% to 38% for Stage I to IV. Costs of healing a pressure ulcer average $11,000. Research Questions for this study were: 1) What is the incidence of heel pressure ulcers in hospitalized acutely-ill patients? 2) Are there differences between subjects who do/do not develop heel pressure ulcers? 3) What are factors that predict who will/will not develop heel pressure ulcers? 4) Which of three devices is most cost effective in preventing pressure ulcers? 5) Do patient characteristics play a role in predicting clinical outcomes? Population: English-speaking hospital inpatients &gt;18 years of age with Braden Score &lt;15 (moderate to high-risk for heel pressure ulcers) were sampled. Sample: Sixty-nine percent of 242 enrolled subjects were ICU patients and fifty percent had impaired mental status. Mean age was 64 years (SD=20 years, range 18-97). Distribution of age was equivalent within device groups. Mean BMI of the sample was 26 (SD=6, range 19-33). Among groups, BMI was equivalent. Males were 58% of the sample. Minorities comprised 35% of the sample (Blacks 15%, Hispanics 16%, and other 4%). Setting: Two military hospitals in South Texas were the sites of the study. Years: The study took place from 1997 to 2001. Variables Studied Together: Patient age, gender, smoking status, diagnosis, co-morbidities, nursing unit, and bed surface were assessed. Intervention: Three common heel pressure-reduction devices used for pressure ulcer prevention were compared (polyester fleece bootie, polyurethane foam foot-prop positioner, and air-waffle boot) for effectiveness. Outcome Variables: Development of pressure ulcer Grade I-IV, length of stay at the time of pressure ulcer development, ulcer healing during stay, cost effectiveness of devices, and co-morbidities were measured. Methods: The study was a prospective, randomized, clinical intervention. Patients were recruited within 18 hours of identification of risk and randomly assigned to one of three devices. A certified wound-care nurse visited patients daily and reassessed Braden risk and skin outcomes. Findings: Analyses on 240 subjects show no statistically significant differences in effectiveness between devices. Twelve pressure ulcers developed in 240 subjects (incidence=5% at both hospitals). Three ulcers occurred in 77 subjects (3.9%) wearing polyester fleece heel protectors, four pressure ulcers developed in 87 subjects (4.6%) wearing the foam foot prop positioner, and five pressure ulcers occurred in 76 subjects (6.6%) wearing the air-filled waffle boots. We found that nursing staff placed pillows under the legs of subjects who were randomized to the polyester fleece bootie, even though we requested that they not do so. Thus, subjects assigned to the polyester fleece bootie received greater pressure relief than they would have received with the device alone. Polyester fleece booties cost $3.52 per pair or $271 to treat 77 subjects. However, it must be remembered that nursing staff supplemented these devices with pillows, which would have cost an additional $14 per pair or $1,349 to treat 77 subjects. Polyurethane foam foot prop positioners cost $29.50 per pair or $2,567 to treat 86 subjects. Air-waffle boots cost $76.00 per pair or $5,776 to treat 76 subjects. From this view, the polyester fleece bootie was the most cost-effective. Conclusions: Smokers and persons with existing pressure ulcers are two times as likely to develop heel ulcers as nonsmokers. Subjects with diabetes mellitus and cardiovascular disease were five times more likely to develop pressure ulcers. Nurses supplemented the polyester fleece bootie with pillows under the calves of the legs although they were asked to refrain from this practice. Therefore, independent nursing action remains a factor in who will/will not develop pressure ulcers. Subjects' compliance with wearing the devices was 85%. As subjects' level of consciousness increased, subjects were less likely to wear any device. Implications: Whether a patient has an existing pressure ulcer anywhere on the body, is a smoker, has diabetes or heart disease can cue nursing staff to monitor the skin of patients very closely for breakdown. Would pillows alone have been as effective as the polyester fleece booties plus pillows? Evidence is provided that pillows may be effective.<br/><br/></td></tr></table>en_GB
dc.date.available2011-10-26T12:35:34Z-
dc.date.issued2002-07en_GB
dc.date.accessioned2011-10-26T12:35:34Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
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