A study published in JWOCN found the use of Prevalon and a heel ulcer prevention protocol led to a 95% decrease in heel pressure ulcers. 2

Dr. Sage adds that ischemic extremities may require vascular intervention if the patient is a suitable candidate and he emphasizes the importance of offloading. Q: Where do you see the pressure ulcer in the lower extremity in your practice? A: In his practice, Dr. Sage most often sees pressure ulcers on hospital patient consults, usually in seriously ill patients who have been on prolonged bed rest. He notes that he does not see nursing home patients or make house calls. Q: What kind of offloading boot or brace do you prescribe to your pressure ulcer patients? A: 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. Multiple guidelines recommend the use of a heel protection device that completely offloads the heel to help prevent the development of heel pressure ulcers. 1,2 Prevalon Heel Protectors are the number one brand of heel protection. 3 They offer continuous heel offloading to protect your patients’ heels. START A TRIAL Choose the optimal heel protectorA cross-referral to the NICE guideline on nutrition support for adults will be made from recommendation 1.4.5. 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 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

Individuals in bed who are completely immobile should have a care plan that includes the use of devices that totally relieve pressure on the heels, most commonly by raising the heels off the bed.” 2 Association of Perioperative Registered Nurses (AORN) Standards Recommended Practices and Guidelines Kazu Suzuki, DPM, CWS, views treating pressure ulcers like treating any other wounds. He starts with a thorough history, figures out when and how the pressure ulcers started, and what kind of pressure formed the ulcers. Similarly, Martin Wendelken, DPM, emphasizes the importance of having a clear understanding of the patient’s activities of daily living and ability to perform those functions, and includes a Braden Scale assessment on the patient. 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. Oftentimes, Dr. Suzuki sees pressure ulcers starting with a period of immobility, such as when patients are acutely ill and hospitalized for a period of time. Sometimes, Dr. Suzuki notes pressure ulcers may develop slowly at home if patients have inappropriately hard bedding surfaces, poor dental condition (which is extremely common in older patients) and gradual malnutrition, which he notes may cause a slow deterioration of their skin.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 stakeholder queried if frail older people should be a separate category in the guideline. No evidence was found about this issue by the current surveillance review. The Waterlow score (1 of 3 tools the guideline recommends considering for assessing ulcer risk) includes items for age, and skin type (for example tissue paper - thin/fragile). No impact on the guideline is currently expected. Dr. Wendelken notes a group 1 mattress overlay may be indicated and is covered by the Centers for Medicare and Medicaid Services (CMS) if the mattress meets the following conditions: Stakeholders asked for the PURPOSE-T risk assessment tool to be added to the guideline. All evidence we have examined for this suggests further study is needed, therefore we will await further evidence before considering it as a recommended tool. The following sentence will also be added to the guideline introduction: 'NHS Improvement has also produced a guide to help deliver a consistent approach to defining and measuring pressure ulcers, and helping to understand the level of pressure damage harm in England: Pressure ulcers: revised definition and measurement framework'.

the patient has any stage pressure ulcer on the trunk or pelvis, and at least one of the conditions A-D below.For the longest time, Dr. Suzuki found the sacral ulcer to be the most prevalent of all pressure ulcers he observed. Now he cites data from the Symposium on Advanced Wound Care Spring/Wound Healing Society (SAWC Spring/WHS) and other national conferences that the posterior heel pressure ulcer may have become the number one most common pressure ulcer, closely followed by sacral ulcers.2,3 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.