Effective Heel Pressure Injury Prevention: More Than Just Pillow Talk

Purpose: In the absence of published data, the singular purpose of this project was to assess the effectiveness of pillows used for heel offloading, across a diverse patient and facility population.

Methods: A retrospective review of aggregate point prevalence data was undertaken.  Point prevalence observations were completed by nurses holding certification through the Wound, Ostomy, Continence Nurses Society.  All patients with pillows used for heel offloading were included. 

Heel offloading was deemed effective if the heels were free of the bed or chair surface at the time of assessment.1 Pillow offloading data were abstracted from a larger data set of preventive care observations and analyzed.

Results: The sample included 449 adult patients, from 32 U.S. hospitals over the course of 21 months; including 14 academic medical centers and 18 Magnet-designated facilities.  Facility bed sizes ranged from 111-1000, with a mean bed size of 462.  Patients from multiple units and all acuity levels are represented.  

100% of the patients had a heel pressure injury prevention protocol in place, with pillow offloading expected as a standard practice.  Effective pillow offloading was employed for 118 (26.2%) of the included patients. 

One or both heels were in contact with the bed or chair surface at the time of assessment for 331 (73.8%) of the included patients.

Conclusions: Anecdotally, wound care practitioners are aware that heel offloading with pillows is rarely employed consistently, correctly, or sustained over time.  This work provides objective proof and should serve as a catalyst for improvement. 

Ineffective offloading, especially at a rate of 3 in 4 patients, leaves a significant number of patients at risk for potentially devastating heel pressure injuries and validates the need to employ more effective and sustainable practices, early, possibly as a first line.