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A retrospective descriptive study of nursing home residents with heel eschar or blisters.

Pressure ulcers on heels are a serious problem in nursing home patients and can lead to complications. Current clinical guidelines recommend leaving dry heel eschar intact, but the evidence for this recommendation is largely based on expert opinion and not always followed. To examine outcomes of heel pressure ulcers in nursing home patients, a retrospective study was conducted by reviewing the charts of patients in 15 different nursing homes who had a heel eschar or a heel blister during a period of 50 months. In all facilities, standard protocol of care consisted of offloading the area and keeping eschar and blisters dry and debriding only if the eschar or blister became loose. A total of 263 heel wounds were identified. Of those, 179 (68%) had eschar and 84 (32%) were blisters. Almost half of all patients (41%) were lost to follow-up. All but one (amputation related to pain from ischemia) of the remaining wounds (n = 154) healed. Ninety-four of the 95 wounds with eschar and 57 of 57 wounds with blisters healed after an average of 11 (SD 9.44) weeks for wounds with eschar and 6 (SD 4.75) weeks for blister-covered wounds. These results suggest practitioners can follow current clinical guidelines for the management of these wounds until further research comparing different protocols of care has been conducted.