Individuals in bed who are completely immobile should have a care plan that includes the use of devices that totally relieve pressure on the heels, most commonly by raising the heels off the bed.” 2 Another study published in JWOCN demonstrated a 100% prevention of both heel pressure ulcers and plantar flexion contracture over a seven month period when using the heel protector device. 3 A cross-referral to the NICE guideline on peripheral arterial disease: diagnosis and management will be made from recommendation 1.4.26. Several stakeholders supplied new evidence, however none was suitable for inclusion in the surveillance review for various reasons (unpublished research, unsuitable evidence type, not in scope, outside search dates). A cross-referral to the NICE guideline on diabetic foot problems: prevention and management will be made from recommendations 1.4.26 and 1.5.24.

Forty patients will be randomised, 20 to receive Prevalon boots and 20 to receive the standard pressure ulcer prevention method used by the ward they are on, to be used whilst in bed. Patients will be assessed daily for 10 days and at each assessment their heels will be photographed using a high resolution digital camera. A blinded assessor will assess all of the photographs to determine whether pressure damage has occurred at the heels. A stakeholder noted the EPUAP references in the guideline need updating, which we will do via an editorial amendment.A stakeholder queried if frail older people should be a separate category in the guideline. No evidence was found about this issue by the current surveillance review. The Waterlow score (1 of 3 tools the guideline recommends considering for assessing ulcer risk) includes items for age, and skin type (for example tissue paper - thin/fragile). No impact on the guideline is currently expected.

Multiple guidelines recommend the use of a heel protection device that completely offloads the heel to help prevent the development of heel pressure ulcers. 1,2 Prevalon Heel Protectors are the number one brand of heel protection. 3 They offer continuous heel offloading to protect your patients’ heels. START A TRIAL Choose the optimal heel protector In one study, implementation of a heel pressure injury prevention protocol that included Prevalon Heel Protector resulted in a 28% decrease in facility- acquired heel pressure injuries over a one-year period. Continued use of the Prevalon Heel Protector over four years coupled with in-depth education, continuous monitoring of compliance, and continual reporting of outcomes to ensure accountability, resulted in a cumulative 72% decrease in heel pressure injuries. 4 Association of Perioperative Registered Nurses (AORN) Standards Recommended Practices and Guidelines Multiple guidelines recommend the use of a heel protection device that completely offloads the heel to help prevent the development of heel pressure ulcers. Prevalon® Heel Protectors are the number one brand of heel protection. They offer continuous heel offloading to protect your patients’ heels. Choose the optimal heel protector A stakeholder queried why high-specification foam mattresses were specifically recommended during surgery for adults but not children. Recommendations on support surfaces for children are less specific on settings than the recommendations in adults and therefore cover using a high-specification mattress in surgery.A stakeholder drew attention to one of their products which prevents pressure ulcers in the operating theatre. The product is a high-specification foam mattress and is therefore covered by the recommendations for high-specification foam mattresses in the guideline. We found no evidence in the current surveillance review specifically concerning this product. Stakeholders requested a definition of a high-specification foam mattress be added to the guideline. It was noted that the guideline examined evidence on a variety of different high-specification mattress types, and the guideline committee were therefore unable to be highly specific about the nature of mattresses and so used the term 'high-specification foam mattress' (which is also used by the NPUAP/EPUAP/PPPIA guideline). A cross-referral to the NICE guideline on sepsis: recognition, diagnosis and early management will be made from recommendation 1.4.18. Another study published in JWOCN demonstrated a 100% prevention of both heel pressure injuries and plantar flexion contracture over a seven month period when using the heel protector device. 3 The primary outcome measures will be (i) incidence of new pressure ulcers at the heel and (ii) resolution of category I heel pressure ulcers. Secondary endpoints will be patient comfort along with patient and staff acceptance of the heel protectors.