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Prevalon Heel Protector I for Heel Pressure Relief - Cushioned Boot for Elevated Heel Support - Designed for Bed Bound Individuals - Qty 1

£43.41£86.82Clearance
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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. Stakeholders asked for the PURPOSE-T risk assessment tool to be added to the guideline. All evidence we have examined for this suggests further study is needed, therefore we will await further evidence before considering it as a recommended tool. 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

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. A study published in JWOCN found the use of Prevalon and a heel ulcer prevention protocol led to a 95% decrease in heel pressure ulcers. 2 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.

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A stakeholder noted the EPUAP references in the guideline need updating, which we will do via an editorial amendment. 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 NICE guideline CG179 recommendations 1.4.3 and 1.5.3 refer to the International NPUAP‑EPUAP [2009] Pressure Ulcer Classification System. This has had 2 revisions since 2009, therefore the reference to a specific year will be deleted. This is a randomised controlled study (RCT) to investigate the effectiveness of Prevalon Boots when used to prevent heel pressure injury among orthopaedic hospital patients. Orthopaedic in-patients with either no visible heel pressure damage or category I heel damage will be identified by their health care provider and willing patients, meeting the inclusion and exclusion criteria, will be consented. 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 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 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. A stakeholder queried the use of the term 'confined' in the guideline introduction because it implies an inability to move rather than reduced mobility, or choosing not to mobilise. This term is used in the first paragraph of the introduction to describe people in whom pressure ulcers typically occur. However the second paragraph goes on to note that all patients are potentially at risk of developing a pressure ulcer, but they are more likely to occur in people who are seriously ill, have a neurological condition, impaired mobility, impaired nutrition, or poor posture or a deformity. Therefore the risk factors in the introduction are wider than patients confined to bed or a chair and cover many different at-risk groups. 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 protectorMultiple guidelines recommend the use of a heel protection device that completely offloads the heel to help prevent the development of heel pressure injuries. 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 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). 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

Ensure that the heels are free of the surface of the bed… Heel-protection devices should elevate the heel completely (offload them) in such a way as to distribute the weight of the leg along the calf without putting pressure on the Achilles tendon.” 3 A cross-referral to the NICE guideline on peripheral arterial disease: diagnosis and management will be made from recommendation 1.4.26. A cross-referral to the NICE guideline on nutrition support for adults will be made from recommendation 1.4.5.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'. 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. 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.

Maintaining alignment [with a pillow] may be difficult if the patient moves. In addition, pillows do not prevent plantar flexion contracture or lateral leg and foot rotation.” 1 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. 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). 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.” 2A 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. 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.

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