Reducing hospital-acquired heel ulcer rates in an acute care facility: an evaluation of a nurse-driven performance improvement project

J Wound Ostomy Continence Nurs. 2008 Jan-Feb;35(1):79-83. doi: 10.1097/01.WON.0000308622.86508.8d.


Purpose: A nurse-driven performance improvement project designed to reduce the incidence of hospital-acquired ulcers of the heel in an acute care setting was evaluated.

Design: This was a descriptive evaluative study using secondary data analysis. Data were collected in 2004, prior to implementation of the prevention project and compared to results obtained in 2006, after the project was implemented.

Subjects and setting: Data were collected in a 172-bed, not-for-profit inpatient acute care facility in North Central California. All medical-surgical inpatients aged 18 years and older were included in the samples. Data were collected on 113 inpatients prior to implementation of the project in 2004. Data were also collected on a sample of 124 inpatients in 2006.

Methods: The prevalence and incidence of heel pressure ulcers were obtained through skin surveys prior to implementation of the prevention program and following its implementation. Results from 2004 were compared to data collected in 2006 after introduction of the Braden Scale for Predicting Pressure Sore Risk. Heel pressure ulcers were staged using the National Pressure Ulcer Advisory Panel (NPUAP) staging system and recommendations provided by the Agency for Health Care Quality Research (AHRQ) clinical practice guidelines.

Results: The incidence of hospital-acquired heel pressure ulcers in 2004 was 13.5% (4 of 37 patients). After implementation of the program in 2006, the incidence of hospital-acquired heel pressure ulcers was 13.8% (5 of 36 patients).

Conclusions: The intervention did not appear to receive adequate staff nurse support needed to make the project successful. Factors that influenced the lack of support may have included: (1) educational method used, (2) lack of organization approved, evidenced-based standardized protocols for prevention and treatment of heel ulcers, and (3) failure of facility management to convey the importance as well as their support for the project.

Publication types

  • Evaluation Study

MeSH terms

  • Acute Disease
  • Attitude of Health Personnel
  • California / epidemiology
  • Documentation
  • Education, Nursing, Continuing
  • Evidence-Based Medicine
  • Heel*
  • Humans
  • Incidence
  • Nursing Assessment
  • Nursing Evaluation Research
  • Nursing Records
  • Nursing Staff, Hospital / education
  • Nursing Staff, Hospital / organization & administration
  • Nursing Staff, Hospital / psychology
  • Organizational Culture
  • Practice Guidelines as Topic
  • Pressure Ulcer / epidemiology
  • Pressure Ulcer / prevention & control*
  • Prevalence
  • Program Evaluation
  • Risk Assessment
  • Severity of Illness Index
  • Skin Care / nursing*
  • Social Support
  • Total Quality Management / organization & administration*