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As we partner with colleagues across the nation in preparation for NPIAP’s World Wide Pressure Injury Prevention day on November 19^th, we are presented with an opportunity to reflect and evaluate the changes we have made to improve our patients’ pressure injury outcomes.  The hard work that has been done and the great outcomes that have been achieved, are triumphs that deserve to be celebrated and shared.  Whereas, the poor outcomes need to be evaluated and opportunities identified to implement evidence-based changes for improvement.

The supine position is the most common surgical position with the patient lying on their back with the head, neck and spine in a neutral position.   This position is not without pressure injury risk as there is increased pressure and shear forces to the scapula, occiput, elbows, sacrum, coccyx, and heels. Today we are going to look at ways to mitigate the risk for pressure injuries (PI) to the heel, related to the supine position. When a patient lies supine, all the pressure of their lower legs and feet rest on the heel.  Heel PI represents approximately one third of pressure injuries acquired, and can result in increased morbidity and mortality. In some cases, heel pressure injuries can lead to amputation of the affected limb.

The National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance reports that hospital-acquired pressure injury prevalence in acute care settings to be approximately 10%; their effects on both patients and hospitals is significant. In the previous blogs, we have discussed what can be done to mitigate risk in the preoperative and intraoperative phases of care.  Today, we will discuss the importance of continued risk assessment and interventions in the postoperative phases of care.

Last time we talked about the Hospital Acquired Pressure Injury (HAPI) and the unnecessary cost, pain and suffering that can accompany them.  Perioperative pressure injuries are real, as Spector, Limcangco, Owens and Steiner (2016) point  out, perioperative pressure injuries can increase the cost of surgery-related hospital stays by an estimated 44% and may add approximately $1.3 billion annually to health care costs in the United States.  

Hospital Acquired Pressure Injuries (HAPI, formally pressure ulcers) can result in a lifetime of pain, suffering and even possibly death for the patient. HAPI rates are reported to the National Database of Nursing Quality Indicators (NDNQI) which is the, “Only national, nursing quality measurement program that provides hospitals with unit-level performance comparison reports (NDNQI, 2010b, p. 2). Healthcare leadership can use the information provided by the NDNQI to establish organizational goals for improvement at the unit level and mark progress in improving patient care and the work environment.