Patient Nonadherence: Traditional Foam/Fiber-Filled Off-Loading Boots for Heel Pressure Injury Prevention and Treatment

Purpose: The study focused on the high rate of patient non-adherence in the daily use of heel off-loading boots for prevention/treatment of heel pressure injuries in a skilled nursing facility and an out-patient wound clinic. Common clinical experience indicates that there is significant patient non-adherence with regard to wearing these boots. This study sought to quantify the degree of non-adherence.

Materials and Methods: A convenience sample of 53 patients was obtained from a skilled nursing facility and an outpatient wound clinic. A verbally administered questionnaire was used for the survey tool. There were no exclusion criteria. Data obtained included estimated duration the off-loading boot is worn in a 24-hour period; patient’s opinions about the boot; reason for off-loading (ulcer/prevention). Patient initials and room numbers were recorded to avoid duplication.

Results:

Setting distribution:

 36 patients (68%) were skilled nursing facility residents

 17 patients (32%) were outpatient wound clinic patients

Indications for off-loading device:

 Ulcer – 36 (68%)

 Preventative – 14 (26%)

 Not Documented – 3 (6%).

Average duration worn in 24-hour period (patient reported):

 0 hours worn – 20 (38%)

 6 hours worn – 10 (19%)

 12 hours worn – 10 (19%)

 18 hours worn – 7 (13%)

 24 hours worn – 6 (11%)

Like or dislike traditional boot (patient reported):

 Like ­– 5 (9%)

 Dislike – 34 (64%)

 No opinion – 14 (26%)

Conclusion: The findings demonstrated that there is a high level of patient nonadherence in the use of heel off-loading boots in these settings. Thirty-eight percent of patients admitted to never wearing the boots, while only 11% wear the boots as directed. Given that this data is patient self-reported, it is likely that patient nonadherence is worse than reported here. This data suggests that alternative strategies or devices should be sought to improve patient adherence with heel off-loading.