Pressure Injury Prevention
Turning schedules, smart surfaces, and the return of a very old problem.
9 min readUpdated February 8, 20262 topics
State of practice
Prevention combines risk assessment on admission, scheduled repositioning, appropriate support surfaces, and skin inspection at handoff. Sensor-equipped mattresses that prompt repositioning are increasingly common; the evidence supports them as a nudge, not a replacement for the schedule.
NPIAP staging
The National Pressure Injury Advisory Panel (NPIAP, formerly NPUAP) stages injuries:
| Stage | Description |
|---|---|
| Stage 1 | Non-blanchable erythema of intact skin |
| Stage 2 | Partial-thickness skin loss with exposed dermis |
| Stage 3 | Full-thickness skin loss; subcutaneous tissue visible |
| Stage 4 | Full-thickness loss with exposed muscle, tendon, bone |
| Unstageable | Base obscured by slough or eschar |
| Deep tissue injury | Persistent non-blanchable deep red / maroon discoloration |
The prevention bundle
- Braden Scale on admission and at defined intervals.
- Repositioning schedule (commonly Q2H, tailored to surface and patient).
- Support-surface matched to risk (foam → alternating pressure → low-air-loss).
- Skin inspection at each handoff, documented.
- Nutrition and hydration review; protein supplementation as indicated.
- Moisture management — incontinence care and skin barriers.
References
- NPIAP/EPUAP/PPPIA Clinical Practice Guideline (2019).
- CMS Hospital-Acquired Conditions — Stage 3 and 4 pressure injuries are non-payable HACs.
- AHRQ Preventing Pressure Ulcers in Hospitals toolkit.
References & further reading
Help us improve
Spotted something wrong, outdated, or unclear? Let the editors know.