1. Crumley, Carolyn MSN, RN, APRN-BC, CWOCN

Article Content


A system process was developed to encourage appropriate utilization of a device to assist in heel pressure redistribution.



Effective October 2008, the CMS will no longer provide higher levels of reimbursement to acute care facilities to treat hospital-acquired stage III and IV pressure ulcers. Heel pressure ulcers continue to be a common site for hospital-acquired pressure ulcers, second only to the sacrum/coccyx area.



Evidence suggests that "floating" the heels off of the mattress with a pillow provides pressure redistribution across the heel, thus lessening the risk of pressure ulcer development. However, for particularly high-risk patients or those patients who are unable to keep their heels positioned with pillows, a device may be necessary to assist with positioning. There is a variety of products available, varying in design and cost. After evaluating several products, our hospital system chose a device that was more expensive than some other options but was felt to meet the needs of our high-risk patients. Our materials management leadership expressed concern that the new product was more expensive than the current products in stock and that overutilization by the nursing staff would create significant costs for our healthcare system.



The hospital wound, ostomy, and continence nurse developed a simple decision tree to assist the nursing staff in determining which patients could be managed by elevating their heel with pillows and which patients would benefit from the heel pressure redistribution device. Nurses were in-serviced on the appropriate use of the product, and the decision tree was posted on each unit and included in the unit wound and skin care notebook.



The nursing staff members express confidence in determining when to order a heel pressure redistribution device, materials management staff are content that the devices are not being ordered excessively, and our hospital-acquired heel pressure ulcer rate continues to decline.



With appropriate tools and knowledge, nurses can manage more expensive supplies appropriately to meet their patient's individual needs.


Implications for Practice:

Although the process described focuses on one specific device, a similar process can be used to support appropriate use of other costly healthcare products.


Section Description

The 2009 NACNS National Conference will be held in St Louis, Missouri, on March 5 to 7. More than 350 clinical nurse specialists (CNSs), graduate faculty, nurse administrators, nurse researchers, and graduate students are registered. This year's theme, "Clinical Nurse Specialists: Vision, Value, Voice," demonstrates the essential leadership skills of the CNS as well as the CNS role in implementing evidence-based practice.


Seventy abstracts were selected for either podium or poster presentations. Again, this year, there is a CNS student poster session. The abstracts addressed CNS practice in 3 practice domains (spheres of influence), emphasizing patient safety and quality care outcomes, leadership, evidence-based practice, and new ways to shape CNS practice. Topics include CNS work activities incorporated into 3 spheres of influence-patients, nursing practice, organization/system-including the development of clinical inquiry skills among staff nurses, use of simulation technology, strategies to maintain clinical excellence, CNS practice in end-of-life care decisions, and many new and thoughtful ideas to support CNS education, practice, and research. Collectively, the abstracts represent the breadth, depth, and richness of the CNSs' contribution to the well-being of individuals, families, communities, as well as to the advancement of the nursing profession.


The conference abstracts were published here to facilitate sharing this emerging new knowledge with those who were unable to attend the conference. As you read each abstract, appreciate the intellectual talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to the health of society through improved outcomes for patients and healthcare organizations. We encourage you to contact individual presenters to network, collaborate, consult, or share your thoughts and ideas on the conference topics. Watch out for next year's call for abstracts and consider submitting for presentation at NACNS' next annual conference in Portland, Oregon, on March 4 to 6, 2010.