Authors (including presenting author) :
Ka Ka POON, KHREH RN Christine KUN, KHREH APN
Affiliation :
(1)2B ward, Department of rehabilitation, Kowloon Hospital
Introduction :
In a rehabilitation setting, patients suffer certain degree of disability. Formation of hospital acquired pressure injuries (PI) is common among geriatric hip fracture and old aged stroke cases. The presence of PI will affect the health status, prolong the rehabilitation progress and increase the length of stay. Therefore, we monitor the PI condition every day. Among various locations of pressure injuries, heel is the second common location for developing pressure injuries (Black, 2012).According to the data from March 2017 to February 2018, 47% of PI are found at heel. Within which more than half of the newly developed heel PI are classified as deep tissue injury or unstageable. The high rate and the severity of heel PI have urged improvement in heel PI prevention care.
Objectives :
The heel skin care programme is going to enhance and improve heel skin care for every in-patients in rehabilitation ward so as to reduce the risk and rate of heel pressure injury during their hospitalization.
Methodology :
It is observed that dry feet are common among old aged people. Besides reducing mobility, dry skin is also a risk factor for the development of PI. Starting from December 2018, a specific heel skincare programme has been introduced. After finishing activities of the day, all patients in a rehabilitation ward receive application of a prophylactic thin layer of white soft paraffin (Vaseline) over both heels. Various types of heel pressure injury prevention devices are given afterwards if necessary. The implementation of heel care practice involves Patient Care Assistants (PCAs) and team nurses. Every evening before bedtime, ward staffs prepare a trolley placing Vaseline, disposable gloves, rubbish bag and handrub. The working staffs are instructed to observe the heel condition before applying Vaseline. The heel caring time for 38 patients is 10 to 15 minutes by 2 to 3 staff. Case nurses and ward in-charge keep ongoing monitoring and supporting of the practice.
Result & Outcome :
The formation of heel PI is markedly reduced by 86%. Before the heel PI prevention program (1/3/2017-28/2/2018), there are 7 number of hospital-acquired heel PI out of 929 number of admission. After the initiation of the heel PI prevention program (1/3/2018 – 28/1/2019), there is 1 number of occurrence out of 1094 number of admission. All patients expressed that the heel PI prevention program helped them in reducing discomfort from poor heel skin integrity. Positive patients' feedback has been obtained. Most of them are appreciated the new routine. A staff survey was conducted at the end of March 2019, more than half of the staff provided positive feedback on this program. They were well accepted the heel care advice and worked closely together in order to strive for a high quality of care to all patients. A few of staff expressed that the program was time-consuming and increased their workload In conlusion, all patients benefit from the heel PI prevention programme. The programme increases observation and interaction. Through the hand touch practice, patients receive feeling of being attentive. Also, the heel care programme requests no extra resource. By using currently available resource and short time, the rate of hospital-acquired heel PIis reduced significantly. As the programme is cost-effective and well accepted, it becomes a routine till now. The programme enhances nursing professionalism too. It involves staff education, nursing creativity and nursing intervention enhancement and improvement with minimal cost. For the way forward, this program may extend to other wards and departments in the coming future.
