Reveal the Heel, an initiative by the tissue viability team to reduce the number of hospital-acquired ulcers, has produced exceptional results on Baddow and Notley wards.
A year on from the project starting on Baddow ward, there was a 100% decrease in pressure ulcers that breached policy. On Notley ward, there was a 35% reduction in just four months.
Pressure ulcers occur when patients who are unable to move spend long periods of time in the same position.
Constant pressure on one area of skin causes the blood to stop flowing normally so the cells die and the skin breaks down. This creates a wound and leads to a risk of infection.
The two biggest areas affected by pressure ulcers are the heel and the sacrum (the base of the spine/top of buttocks).
Whereas completely relieving pressure on the sacrum is difficult, the use of a pillow from under a patient’s lower leg or deflating the end cells on an air mattress can alleviate heel pressure completely.
Elisabete Martins, tissue viability lead nurse, explained why the project started: “More than a year ago, we noticed patients coming in with bandages that were not being taken off in a timely manner, and sometimes when we did take them off, we found pressure ulcers. So we tried to come up with a solution to decrease that problem.
“In June 2018, our number of hospital-acquired pressure ulcers was quite high – above the national average – so we volunteered to participate in a national collaboration with NHSI.
“We selected two wards and senior sisters from those wards came with me to meet consultants from NHSI to work in group to come up with something innovative. We knew we needed to do something creative, and we wanted a name that was catchy.
“We worked closely with Baddow ward and designed a one-year project to reduce pressure to the heel by providing training for staff and raising awareness about the importance of elevating heels. We also created small triangles to communicate to the team who the patients were that needed their heels elevated.
“After one year on Baddow we didn’t have any at all – a decrease of 100%. After Baddow, we transferred the project to Notley ward. We analysed the data and designed a plan in cooperation with the staff. It’s a trauma ward so the patients are of higher risk.
“It was a four-month project and we had a decrease of 35% in pressure ulcers. Getting good results in Notely makes me feel optimistic for other wards. From Notley, we’ve also implemented the project in Stroke and Terling.
“This year Writtle had the highest numbers so it’s been flagged that they need our help. In Writtle we are trialling a pathway to elevate the heel that eventually I would like to take everywhere.”
Elisabete works alongside nurse Gemma Read, who said the aim of the project has been to permanently change practice on wards.
“The prevention side is so important. If you stop it from happening or catch it in those early stages, it won’t develop. It’s a reminder to get people to constantly check the patients’ heel so we can intervene early if there is pressure damage occurring.
“If a patient hasn’t been moved for a long time, the damage can go down to the bone and it’s very hard to heal that. The human and economic burden that a pressure ulcer causes is so huge that if we can prevent just one then we have gained. The habits have stayed in the wards and they are implementing it as normal practice.”