Heel Pressure Research Articles

Prevention of Heel Pressure Injuries and Plantar Flexion Contractures With Use of a Heel Protector in High-Risk Neurotrauma, Medical, and Surgical Intensive Care Units: A Randomized Controlled Trial.

The purpose of this study was to compare the use of a heel protector to standard of care (pillows) in the prevention of hospital-acquired pressure injuries (HAPI) of the heels and prevention of plantar flexion contractures. Randomized controlled trial. The study took place on a surgical intensive care unit, medical intensive care unit, and neurotrauma intensive care unit. Inclusion criteria were a minimum of 5 days of sedation related to care for a critical illness, immobility for 6 to 8 hours before study initiation, a Braden Scale for Pressure Sore Risk score 18 or less, and a mobility subscale score 2 or less. Patients were included if they had preexisting heel pressure injury or plantar flexion contracture. The sample comprised 54 subjects; 37 were randomly allocated to the intervention group and 17 to the control group. Their average age-mean (standard deviation)-was 40.7 (14.96) years in the control group and 44.6 (17.15) years in the intervention group. Data were collected from patients' electronic medical records. We recorded subject demographics, presence of diabetes mellitus or peripheral vascular disease, Glasgow Coma Scale scores (every shift), Braden Scale for Pressure Sore Risk scores (every shift), heel skin assessments (every shift), goniometric measurements (every other day), and adverse events (every shift). Assessments and measurements were continued until the patient was discharged from the study. None of the patients in the intervention group developed HAPI of the heels, as compared to 7 in the control group (0% vs 41%, P < .001). Patients in the intervention group had a significantly greater decrease in goniometric scores (mean decrease = 1.4 ± 2.25) compared to the control group by day 3 (mean decrease = 0.1 ± 0.52 P = .004) and the last study day (mean decrease = 2.0 ± 3.02 for the intervention group vs 0.07 ± 0.96 for the control group; P < .001). Study findings indicate that a heel protector that ensures off-loading and maintains the foot in a neutral position is more effective for prevention of HAPI of the heel and contractures as compared to standard care using pillows to position the heel and redistribute pressure.

Prevalence and severity of peripheral arterial disease among patient with heel pressure ulcer: a retrospective study of 42 patients.

Heel pressure ulcer is a major complication in elderly hospitalized patients. The association with peripheral arterial disease (PAD) which is also a frequent disease in this population is poorly known. The aim of this study was to assess the prevalence of PAD and critical limb ischemia (CLI) in patients with heel pressure ulcer. Patients referred to the vascular medicine department for heel pressure ulcer from October 2014 to June 2015 were included in the study. The assessment of peripheral arterial disease was made with the results of ankle brachial index and/or doppler ultra sound of lower limb arteries. Toe systolic pressure and transcutaneous pressure (TcPO2) were also recorded, and the diagnosis of critical limb ischemia was made according to the TASC 2 criteria. The population was composed with 42 patients (women 43%, men 57%). The mean age was 81±11 years. Heel pressures ulcers were diagnosed in the following situations: lower limb fracture (31%), acute medical illness (21%), multiple chronic conditions (28%) and critical care unit hospitalization (7%). A peripheral arterial disease was present in 31 patients (73%), and a critical limb ischemia in 7 patients. For 18 patients, PAD was not known in their past medical history, and this was the case of 5 patients among those with critical limb ischemia. A revascularization was performed in 12 patients, and 5 patients undergo a lower limb amputation. 12 patients were died at 3 months. PAD is frequent among patients with heel pressure ulcer, and is often unknown. The functional and vital prognostic are poor, and the results of our study emphasize the importance of screening PAD in the evaluation of heel pressure ulcer risk.

The Effect of Offloading Heels on Sacral Pressure

Offloading a patient’s heels during supine surgical procedures is a common practice to prevent heel pressure injuries. This practice may increase sacral pressure and jeopardize sacral skin integrity, but prophylactic dressings may help protect sacral skin. The purpose of this study was to examine the effects of offloading the heels and of multilayered silicone foam dressings on sacral pressure. We measured the sacral pressure of 50 healthy volunteers using a pressure-mapping system under four conditions: heels not offloaded and sacral dressing applied, heels offloaded and dressing applied, heels not offloaded and no dressing, and heels offloaded and no dressing. We used linear mixed-effects modeling to compare the effects of these conditions on sacral pressure. Offloading the heels significantly increased sacral pressure (P < .001), whereas the dressing had no effect on sacral pressure (P = .49). Offloading a patient’s heels may increase the risk of sacral pressure injuries.

Effect of Sacroiliac Joint Manipulation on Selected Gait Parameters in Healthy Subjects.

The sacroiliac joints have complicated biomechanics. While the movements in the joints are small, they exert a significant effect on gait. This study aimed to assess how sacroiliac joint manipulation influences selected gait parameters. The study enrolled 57 healthy subjects. The experimental group consisted of 26 participants diagnosed with dysfunction of one sacroiliac joint. The control group was composed of 31 persons. All subjects from the experimental group underwent sacroiliac joint manipulation. The experimental group showed significant lengthening of the step on both sides and the stride length in this group increased as well. Moreover, the duration of the stride increased (p=0.000826). The maximum midfoot pressure was higher and maximum heel pressure decreased. The differences were statistically significant. 1. Subclinical dysfunctions of the sacroiliac joints may cause functional gait disturbance. 2. Manipulation of the iliosacral joint exerts a significant effect on gait parameters, which may lead to improved gait economy and effec-tiveness. 3. Following manipulation of one iliosacral joint, altered gait parameters are noted on both the manipulated side and the contralateral side, which may translate into improved quality of locomotion.

Dry skin and pressure ulcer risk: A multi-center cross-sectional prevalence study in German hospitals and nursing homes

BackgroundPressure ulcers are a serious health problem in medical and nursing care. Therefore, effective prevention is crucial. Major pressure ulcer risk factors have been identified but the particular role of dry skin (xerosis cutis) is unclear. ObjectivesTo investigate possible associations between dry skin and pressure ulcers focusing on the sacrum/trochanter and at heel/ankle skin areas. DesignTwo multicenter cross-sectional studies. Settings/participantsIn 2014 and 2015 thirty nursing homes and thirteen hospitals in Germany participated. In total 3837 participants were included. Mean age was 76.1 (SD 15.5) years. MethodsSkin assessments and data collection were performed by trained nurses based on a standardized data collection form. Descriptive comparisons and multilevel logistic regressions predicting pressure ulcers at sacrum/trochanter and ankle/heel were conducted. ResultsThe prevalence of skin dryness at the trunk was significantly higher for subjects with pressure ulcers category 2+ at the sacral area compared to without (39.0% vs. 24.4%, p=0.010). Adjusted to demographic variables, mobility and type of institution dry skin at the trunk was no longer associated with pressure ulceration (OR 1.11 (95% CI 0.62–2.00)). 71.9% of patients with heel/ankle pressure ulcers category 2+ were affected by dry skin at legs or feet, compared to 42.8% of subjects without pressure ulcers (p<0.001). In the adjusted analysis the OR was 1.85 (95% CI 0.83–4.14). ConclusionsStudy results indicate that dry skin at the feet may be considered as a risk factor for heel pressure ulcer development. Skin dryness may be less important for sacral pressure ulcers. Therefore, the variable skin status should be better defined in future studies and pressure ulcer risk models. Results further support differences in pressure ulcer aetiologies between anatomical locations.

Pressure-relieving devices for preventing heel pressure ulcers

Reason for withdrawal from publication 17/5/17 This protocol has been withdrawn from publication.

The Relationship between Plantar Fasciitis and Plantar Heel Pressure

Objective: The presence of increased medial heel plantar pressure in plantar fasciitis has been debated, with clinicians often utilizing pressure-relieving devices, such as heel pads and cups, as a means of management. Method: Plantar pressures in a sample of 15 adult participants with chronic plantar fasciitis were compared to plantar pressures of the 15 adult participants forming the control group, who were matched for age, gender and weight. Results: There were no significant differences in peak heel plantar pressure (p = 0.244), lateral peak plantar pressure (p = 0.876), forefoot peak plantar pressure (p = 0.576) and the Forefoot to Rear foot peak pressure ratio (p = 0.242) between the 2 groups. However, there was a significant difference (p = 0.015) in medial heel peak plantar pressure between the 2 groups, with the plantar fasciitis group having lower medial heel pressure than the control group. . Conclusion: The findings in this study suggest that there is no relationship between peak medial heel plantar pressures and chronic medio-plantar heel pain in plantar fasciitis. There is also no shift in pressure from the symptomatic medio-plantar heel region to the latero-plantar heel and forefoot regions. As a result, pressure may not play a part in the pathophysiology of plantar fasciitis.

Heel pressure ulcer, prevention and predictors during the care delivery chain - when and where to take action? A descriptive and explorative study.

BackgroundHazardous healthcare settings, for example acute care, need to focus more on preventing adverse events and preventive actions across the care delivery chain (i.e pre-hospital and emergency care, and further at the hospital ward) should be more studied. Pressure ulcer prevalence is still at unreasonably high levels, causing increased healthcare costs and suffering for patients. Recent biomedical research reveals that the first signs of cell damage could arise within minutes. However, few studies have investigated optimal pressure ulcer prevention in the initial stage of the care process, e.g. in the ambulance care or at the emergency department. The aim of the study was to describe heel pressure ulcer prevalence and nursing actions in relation to pressure ulcer prevention during the care delivery chain, for older patients with neurological symptoms or reduced general condition. Another aim was to investigate early predictors for the development of heel pressure ulcer during the care delivery chain.MethodsExisting data collected from a multi-centre randomized controlled trial investigating the effect of using a heel prevention boot to reduce the incidence of heel pressure ulcer across the care delivery chain was used. Totally 183 patients participated. The settings for the study were five ambulance stations, two emergency departments and 16 wards at two hospitals in Sweden.ResultsA total of 39 individual patients (21 %) developed heel pressure ulcer at different stages across the care delivery chain. Findings revealed that 47–64 % of the patients were assessed as being at risk for developing heel pressure ulcer. Preventive action was taken. However, all patients who developed pressure ulcer during the care delivery chain did not receive adequate pressure ulcer prevention actions during their hospital stay.Discussion and ConclusionsIn the ambulance and at the emergency department, skin inspection seems to be appropriate for preventing pressure ulcer. However, carrying out risk assessment with a validated instrument is of significant importance at the ward level. This would also be an appropriate level of resource use. Context-specific actions for pressure ulcer prevention should be incorporated into the care of the patient from the very beginning of the care delivery chain.Trial registration ISRCTN85296908.Electronic supplementary materialThe online version of this article (doi:10.1186/s13049-016-0326-0) contains supplementary material, which is available to authorized users.

The Lived Experience of the Soft Heel Cast, Management of Heel Pressure Ulcerations in the Acute Setting, an Interpretative Phenomenological Study

Background: Prevention of pressure ulceration is a key quality indicator throughout both acute and community settings however, good quality evidence and national guidance on how to prevent heel pressure is limited [1]. An alternative offloading device a soft heel cast has been introduced into Podiatric practise. This qualitative research study aims to seek the patient perspective of the soft heel cast. Methods: Patients who had been provided with the soft heel cast were purposively sampled via a recruitment letter. The aim was to recruit between six and eight participants. All participants opted in and provided their written consent to take part in the study. The data was collected using the exemplary method for an Interpretative phenomenological approach (IPA) [2]. All interviews were transcribed and the six stages of analysis appropriate to IPA followed meticulously. Results: The analysis identified three inter-related Superordinate themes. It revealed the intimate relationship between the most complex and powerful theme of pain alongside, ‘ergonomics of the optimal offloading device’ and the participant’s ‘ability to cope’. Five sub-themes were identified and discussed; suffering, comfort, size, identity and ulceration duration. Conclusion: Pain is a complex and subjective phenomenon which cannot be measured directly rather established by the person experiencing it [3]. Pain is unique and often difficult to describe, as a consequence it remains poorly understood and inadequately managed. Quality of life should be considered an equal factor alongside the wellknown triad of ‘how to heal a wound’. This research clearly highlights how patients often suffer in silence.

One Size Does Not Fit All: Nurse Education for Properly Fitted Anti-embolism Compression Stockings

The use of anti-embolism compression stockings in the pre and post-operative care units (PACU) are a non-invasive prophylactic nursing intervention that has shown to aide in the prevention of deep vein thrombosis (DVT). However, if the nursing staff is not properly trained in the application and management of anti-embolism compression stockings, patients are placed at increased risk for developing heel pressure ulcers and compromised skin integrity.

Heel pressures with generic and focused rigid heel cast devices while in a static supine and seated position.

To identify if the choice of material used to make focused rigid cast (FRC) and generic heel cups has an effect on heel pressure in healthy individuals during a static supine and seated position. A repeated measure design was used to compare the effect of two focused rigidity heel devices made from different materials (3M semi-rigid and Benecast FLEX) and a generic polymer gel heel cup device on barefoot heel pressures. Subjects had heel pressures taken while barefoot and with the three different heel devices while in a supine and seated position using the device. We recruited 32 healthy participants (21 females, and 11 males). When comparing Benecast FLEX and 3M semi-rigid focused rigidity casts with barefoot and the generic heel cups significant reductions in pressures were seen in all areas while seated and in the distal area while supine. However, there was no statistical difference between the two FRC devices, or between barefoot and the generic heel cup in either position. This study demonstrates that FRC heel devices effectively reduced heel pressures in healthy individuals and therefore could be used in practice when a reduction in pressure is required for the management of heel pressure ulcers in bedbound or chair-bound patients.

Using heel protectors for the prevention of hospital-acquired pressure ulcers.

Pressure ulcers are a frequent, but often preventable, occurrence among patients in acute care facilities, and the heel is one of the anatomical locations most commonly affected. Multiple clinical guidelines recommend the use of robust assessments to identify at-risk patients and the application of heel protection devices to reduce the likelihood of developing heel pressure ulcers. A quality improvement initiative involving robust skin-assessment practices, staff education, and the use of heel protection devices was analysed retrospectively to evaluate the efficacy of current practice interventions. These analyses revealed that the incidence of heel pressure ulcers was inversely correlated with the number of heel protectors used at two large acute NHS teaching hospitals in inner London, and that the consistent and early use of heel protectors improved patient outcomes and reduced costs of care.

Knee osteoarthritis active living assistant side force measurements as potential means for assessing knee osteoarthritis

Purpose: The lifetime risk of developing symptomatic knee osteoarthritis (KOA) has been estimated to be 45%. Knee abduction/adduction moment (KAM) is recognized as a primary marker of KOA progression. A 1% increase in peak external KAM has been linked to a greater than 6-fold increase in the risk of KOA progression. Due to high costs, and limited measurement granularity, established KAM measurement techniques are an impractical means for tracking KOA progression. Measurement of KAM is currently limited to gait laboratories, which utilize motion capture systems to determine knee moments. KOA often takes decades to develop. Identifying statistically significant changes in KAM on a year over year (or more frequent) basis therefore requires a higher degree of granularity than current techniques offer. Other attempts at measuring KAM during free ambulation have neither achieved complete independence from lab measurements, nor generated significantly greater granularity. In this work, a novel means of measuring a KAM proxy during free ambulation is presented, offering high measurement accuracy and granularity. We have developed an orthotic leg brace containing pressure sensors located on the inner and outer shank and thigh regions that measure side forces. From these side forces, we have measured the forces generated by the knee that are balanced by the legbrace. The purpose of this particular study was to assess the potential for this KAM proxy to differentiate between knees with diagnosed KOA and knees without KOA. We performed a preliminary test with a passive variant of a Knee OsteoArthritis Active Living Assistant (KOAALA) prototype (Figure 1) on a 75- year old male test subject with a differential KOA diagnosis between his left and right knee, and a young control subject in good health. Sessions were for 50 strides on a treadmill at 1m/s. The test subject walked one session with the sensorized legbrace on his left (afflicted) leg, then one session with the sensorized legbrace on his right (unafflicted) leg. The control subject walked one session with the sensorized legbrace on his left leg. Legbrace side force sensors were sampled at 4,608 samples per second and data was logged to a micro-secure-digital-card with a granularity of 4g. Additional Gait measures logged included: knee angle, shank tilt angle, shank lean angle, heel pressure, ball-of-foot pressure, foot angle and heel strike timing. After testing, data were processed using Wolfram’s Mathematica; processed data was compared. View Large Image Figure ViewerDownload Hi-res image Download (PPT) Results: The left/right panels of Figure 2 shows the data logged by KOAALA for average heel force (purple), ball-of-foot force (red) and average side force (blue) along with the minimum side force (gold) and maximum side force (green) versus percent of gait cycle of the test subject’s left and right legs respectively. Figure 3 shows the analogous data for the control subject. The side forces began in the lateral direction prior to heel strike and peaked immediately following heel strike and again peaked in the lateral direction prior to toe off. The left leg graph, however, has dramatically different characteristics from both the test subject’s right leg and the control subject. Specifically, in the healthy and in the unafflicted knee the pressure in the period between the peaks was nominal, while the test subject’s left leg (afflicted) side force measurements showed a substantial spike in the medial direction during the transition of support from heel to ball-of-foot. Conclusions: Our novel method for measuring a KAM proxy measures the primary discernable side forces exerted by the legbrace. Sensor calibration has not been established preventing analysis of relative pressures between the brace and traditional KAM measurement methods, but the series of spikes is not generally discernable in traditional methods. Further testing will be required to ascertain if these peaks are anomalous; peculiar to the brace/test; or are simply not detected by traditional methods. The high accuracy and fine granularity side force measurements our method provides has the potential of creating a novel means of tracking/managing KOA. The peak in the medial direction of the afflicted leg during the transitional support phase shows potential for this KAM proxy as a biomarker for KOA.

Studio di coorte sull'incidenza dei decubiti al calcagno in pazienti immobilizzati da gesso agli arti inferiori presso l'Istituto Ortopedico Rizzoli e dei possibili fattori di rischio

Pressure sores, especially at the heel, are a side effect of the cast. To assess the incidence of late skin complications (heel pressure sores) of a cast and determine risk factors. All consecutive patients treated with a leg cast over a 16 months observation time were recruited. Risk factors were identified by the nurse that placed the cast and skin lesions classified with the NPUAP scale when the cast was removed. In the 216 enrolled patients 17.6% (38) developed a pressure sore: 16/124 in orthopedic wards; 22/92 in oncology wards. The multivariate analysis identified the following risk factors: administration of cytotoxic drugs (p = 0.033; OR = 2.61; having a cancer did not increase the risk); skin redness before cast application (p = 0.001; OR = 4.44) and having reported symptoms after the application (p = 0.000; OR = 7.86). Pressure sores were mainly stage 1 and only 6/216 (2.4%) > or = stage II. The type of plaster cast, the material, the number of days it was worn and having had a surgery are not significant risk factors. Pressure sores related to leg plaster casts are a frequent complication in at risk sub-groups. The acknowledgement and identification of specific risk factors may allow to identify and evaluate preventive interventions to improve the care of these patients.

Preventing Heel Pressure Ulcers: Sustained Quality Improvement Initiative in a Canadian Acute Care Facility.

The setting for this quality improvement initiative designed to reduce the prevalence of facility-acquired heel pressure ulcers was a regional, acute-care, 490-bed facility in Ontario, Canada, responsible for dialysis, vascular, and orthopedic surgery. An interdisciplinary skin and wound care team designed an evidence-based quality improvement initiative based on a systematic literature review and standardization of heel offloading methods. The prevalence of heel pressure ulcers was measured at baseline (immediately prior to implementation of initiative) and at 1 and 4 years following implementation. The prevalence of facility-acquired heel pressure ulcers was 5.8% when measured before project implementation. It was 4.2% at 1 year following implementation and 1.6% when measured at the end of the 4-year initiative. Outcomes demonstrate that the initiative resulted in a continuous and sustained reduction in facility-acquired heel pressure ulcer incidence over a 4-year period.

Four biomechanical and anthropometric measures predict tibial stress fracture: a prospective study of 1065 Royal Marines.

Tibial stress fractures (TSFs) cause a significant burden to Royal Marines recruits. No prospective running gait analyses have previously been performed in military settings. We aimed to identify biomechanical gait factors and anthropometric variables associated with increased risk of TSF. 1065 Royal Marines recruits were assessed in week 2 of training. Bilateral plantar pressure and three-dimensional lower limb kinematics were obtained for barefoot running at 3.6 m/s, providing dynamic arch index, peak heel pressure and lower limb joint angles. Age, bimalleolar breadth, calf girth, passive hip internal/external range of motion and body mass index (BMI) were also recorded. 10 recruits who sustained a TSF during training were compared with 120 recruits who completed training injury-free using a binary logistic regression model to identify injury risk factors. 4 variables significantly (p<0.05) predicted increased risk of TSF (ORs and 95% CI): smaller bimalleolar width (0.73, 0.58 to 0.93), lower BMI (0.56, 0.33 to 0.95), greater peak heel pressure (1.25, 1.07 to 1.46) and lower range of tibial rotation (0.78, 0.63 to 0.96). Reduced impact attenuation and ability to withstand load were implicated in tibial stress fracture risk.

A predictive model for pressure ulcer outcome: the Wound Healing Index.

The purpose of this learning activity is to provide information regarding the creation of a risk-stratification system to predict the likelihood of the healing of body and heel pressure ulcers (PrUs). This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. After participating in this educational activity, the participant should be better able to:1. Explain the need for a PrU risk stratification tool.2. Describe the purpose and methodology of the study.3. Delineate the results of the study and development of the Wound Healing Index. : To create a validated system to predict the healing likelihood of patients with body and heel pressure ulcers (PrUs), incorporating only patient- and wound-specific variables. The US Wound Registry data were examined retrospectively and assigned a clear outcome (healed, amputated, and so on). Significant variables were identified with bivariate analyses. Multivariable logistic regression models were created based on significant factors (P < .05) and tested on a 10% randomly selected hold-out sample. Fifty-six wound clinics in 24 states : A total of 7973 body PrUs and 2350 heel PrUs were eligible for analysis. Not applicable : Healed PrU MAIN RESULTS:: Because of missing data elements, the logistic regression development model included 6640 body PrUs, of which 4300 healed (64.8%), and the 10% validation sample included 709 PrUs, of which 477 healed (67.3%). For heel PrUs, the logistic regression development model included 1909 heel PrUs, of which 1240 healed (65.0%), and the 10% validation sample included 203 PrUs, of which 133 healed (65.5%). Variables significantly predicting healing were PrU size, PrU age, number of concurrent wounds of any etiology, PrU Stage III or IV, evidence of bioburden/infection, patient age, being nonambulatory, having renal transplant, paralysis, malnutrition, and/or patient hospitalization for any reason. Body and heel PrU Wound Healing Indices are comprehensive, user-friendly, and validated predictive models for likelihood of body and heel PrU healing. They can risk-stratify patients in clinical research trials, stratify patient data for quality reporting and benchmarking activities, and identify patients most likely to require advanced therapeutics to achieve healing.

Effects of different heel angles in sleep mode on heel interface pressure in the elderly

BackgroundThe heels are one of the most common sites of pressure ulcers, and the incidence rate in the elderly aged 70years or older is high. Although there is literature on heel interface pressure, the heel interface pressure of the elderly in different postures has not yet been explored, which will be investigated in this study, as well as the effects of different foot positions. Their skin conditions will also be examined. MethodsTwenty-five females and twenty-six males, 70years old or older, are evaluated while lying down, with only their naked foot in its natural position on a mattress, as well as placed on a standard or pressure-relieving mattress in different positions. The moisture, sebum content, and elasticity of the skin of the heel are tested. FindingsThe heel of most of the participants is positioned at a 60°–69° or 90°–99° angle to the support surface. The heel interface pressure is the greatest when the foot is upright. The age, weight, and body mass index have no significant impacts. The moisture and sebum content are extremely low while elasticity is normal. InterpretationThe relaxed position of the foot is in neutral external rotation and upright positions. A greater amount of pressure is experienced when the foot is upright. The pressure-relieving mattress is more effective for reducing heel pressure but may not apply to all cases. Finally, the skin of the heel is dry and lacks sebum, which implies greater risk of developing heel sores.

Prevention of heel pressure ulcers among older patients – from ambulance care to hospital discharge: A multi-centre randomized controlled trial

The aim was to investigate the effect of an early intervention, a heel suspension device boot, on the incidence of heel pressure ulcers among older patients (aged 70+). BackgroundPressure ulcers are a global healthcare issue; furthermore, the heel is an exposed location. Research indicates that preventive nursing interventions starting during the ambulance care and used across the acute care delivery chain are seldom used. MethodsA multi-centre randomized control study design was used. Five ambulance stations, two emergency departments and 16 wards at two Swedish hospitals participated. Altogether, 183 patients were transferred by ambulance to the emergency department and were thereafter admitted to one of the participating wards. ResultsSignificantly fewer patients in the intervention group (n=15 of 103; 14.6%) than the control group (n=24 of 80; 30%) developed heel pressure ulcers during their hospital stay (p=0.017). ConclusionsPressure ulcer prevention should start early in the acute care delivery chain to increase patient safety.

Relieving the pressure at LNS 2015.

British Journal of NursingVol. 24, No. Sup15 London Nurse Show 2015Relieving the pressure at LNS 2015Rachel WebbRachel WebbSearch for more papers by this authorRachel WebbPublished Online:12 Aug 2015https://doi.org/10.12968/bjon.2015.24.Sup15.S10AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Brindle CT (2010) Outliers to the Braden scale: identifying high-risk ICU patients and the results of prophylactic dressing use. World Council of Enterostomal Therapists Journal 30(1): 11–8 Google ScholarNational Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance (2014a) Prevention and Treatment of Pressure Ulcers: Clinical Practice Guide. http://www.epuap.org/guidelines/ (accessed 28 July 2015) Google ScholarNational Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance (2014b) Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. http://tinyurl.com/os6qyar (accessed 28 July 2015) Google ScholarSantamaria N, Gerdtz M, Sage S et al. (2015a) A randomised controlled trial of the effectiveness of soft silicone multi-layered foam dressings in the prevention of sacral and heel pressure ulcers in trauma and critically ill patients: the border trial. Int Wound J 12(3): 302–8 Crossref, Medline, Google ScholarSantamaria N, Gerdtz M, Liu W et al. (2015b) Clinical effectiveness of a silicone foam dressing for the prevention of heel pressure ulcers in critically ill patients: Border II Trial. J Wound Care (in press) Medline, Google Scholar FiguresReferencesRelatedDetails 12 August 2015Volume 24Issue Sup15ISSN (print): 0966-0461ISSN (online): 2052-2819 Metrics History Published online 12 August 2015 Published in print 12 August 2015 Information© MA Healthcare LimitedPDF download