Kazu Suzuki, DPM, CWS, views treating pressure ulcers like treating any other wounds. He starts with a thorough history, figures out when and how the pressure ulcers started, and what kind of pressure formed the ulcers. Similarly, Martin Wendelken, DPM, emphasizes the importance of having a clear understanding of the patient’s activities of daily living and ability to perform those functions, and includes a Braden Scale assessment on the patient. In one study, implementation of a heel pressure ulcer prevention protocol that included Prevalon Heel Protector resulted in a 28% decrease in facility- acquired heel pressure ulcers 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 ulcers. 4 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

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.b) Distribute or display publicly the Training Video or any derivative works, in whole or in part, in any medium and for any purpose other than for internal training and educational purposes. Our expert panelists offer essential keys to diagnosis, share their insights on offloading modalities, and discuss mattresses and beds to help resolve pressure issues. Q: What is your diagnosis and treatment approach when you see a new patient with a pressure ulcer in lower extremities? A: A stakeholder noted the EPUAP references in the guideline need updating, which we will do via an editorial amendment. 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. The following sentence will also be added to the guideline introduction: 'NHS Improvement has also produced a guide to help deliver a consistent approach to defining and measuring pressure ulcers, and helping to understand the level of pressure damage harm in England: Pressure ulcers: revised definition and measurement framework'.

Additionally, Dr. Wendelken finds pressure ulcers in areas such as the medial first and lateral fifth metatarsal heads. Other less common areas where pressure ulcers form are the proximal fibula head and the anterior ankle, according to Dr. Wendelken. He notes the anterior ankle ulcer is commonly caused by a dressing that one did not properly apply and is usually too tight. the patient has any stage pressure ulcer on the trunk or pelvis, and at least one of the conditions A-D below. Association of Perioperative Registered Nurses (AORN) Standards Recommended Practices and Guidelines 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 study published in JWOCN found the use of Prevalon and a heel pressure injury prevention protocol led to a 95% decrease in heel pressure injuries. 2

A:

A stakeholder requested we consider new evidence about the association between moisture-associated skin damage and pressure ulcers. However no new evidence was supplied. The evidence already identified by the surveillance review on incontinence and pressure ulcers was consistent with the guideline.

Under the Limited License, Licensee has the rights to use and display the Training Video internally to its employees. Licensee agrees that the Limited License excludes the following rights to: 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 Dr. Sage evaluates the wound for signs of infection and evaluates the foot for signs of ischemia. If infection is present, he says debridement and/or antibiotics may be necessary, but he does not debride stable, non-infected blisters or eschars. When a new patient presents with what appears to be a pressure ulcer on the lower extremity, Dr. Wendelken proceeds with a vascular assessment that includes an ankle/brachial index, a neuropathy assessment that utilizes the Semmes Weinstein test, and an assessment of mobility and range of motion. A cross-referral to the NICE guideline on antimicrobial stewardship: systems and processes for effective antimicrobial medicine use will be made from recommendations 1.4.21, 1.4.22, 1.5.18 and 1.5.19. Dr. Sage is a Professor and the Chief of the Section of Podiatry at the Department of Orthopaedic Surgery and Rehabilitation at the Loyola University Stritch School of Medicine in Maywood, Ill.A stakeholder wanted to draw attention to limitations of moist wound care. However the current surveillance review identified 2 RCTs showing benefit of moist dressings, which agrees with the guideline recommendation to consider using a dressing that promotes a warm, moist wound healing environment. In his practice, Dr. Wendelken most often finds pressure ulcers on the heel, typically the retrocalcaneal surface and the lateral heel. He also encounters numerous pressure ulcers on the ankle over the malleolus as well as pressure ulcers along the lateral aspect of the foot (base of the fifth metatarsal at the styloid process). In his clinic, Dr. Suzuki has seen quite a few “ankle” pressure ulcers over the lateral malleolus or even the medial malleolus as some of his patients sleep on their sides. This may turn the ulcer into a chronic ulceration at the tip of the malleolus, according to Dr. Suzuki.