Practice Tip of the Week | Pressure Injury Prevention Starts With Us

By Marissa Hudler MSN, RN, WCC, CFCN, OMS in collaboration with the TNA Nursing Practice Committee 

On November 20, 2025, healthcare professionals worldwide will observe Worldwide Pressure Injury Prevention Day, an essential reminder of our collective responsibility to protect patients from one of the most preventable yet persistent complications in healthcare. The National Pressure Injury Advisory Panel (NPIAP) defines a pressure injury as, "localized damage to the skin and/or underlying tissue, usually over a bony prominence or related to a medical or other devices, resulting from prolonged pressure or pressure in combination with shear." 

The Magnitude of the Problem 

According to the Agency of Healthcare Research and Quality, hospital-acquired pressure injuries (HAPIs) affect approximately 2.5 million people annually in the United States. The NPIAP estimates that pressure injuries contribute to 60,000 deaths each year, with 2%-40% of acute care patients developing a pressure injury during their hospitalization. 

The financial burden is equally staggering. The cost to treat a pressure injury ranges from $20,900 to $151,700, with total estimated costs exceeding $26.8 billion annually in the United States. Beyond statistics, these injuries cause profound suffering, pain, infection risk, prolonged hospitalization, and diminished quality of life. 

Identifying At-Risk Patients 

The Braden Scale is among the most widely used assessment tools worldwide to identify patients at risk of developing a pressure injury. This validated instrument evaluates six critical domains: sensory perception, skin moisture, activity level, mobility, nutrition, and friction/shear. Scores range from 6 to 23, with 15-18 indicating at-risk, 13-14 moderate risk, 10-12 high risk, and ≤9 very high risk.  

The National Pressure Injury Advisory Panel (NPIAP) recommends performing a risk assessment as soon as possible, but within 8 hours of admission, with reassessment based on changes in patient acuity or significant changes in condition. However, remember that the Braden Scale should be used as part of a comprehensive, structured assessment, along with the NPIAP Standardized Pressure Injury Prevention Protocol Checklist (SPIPP-Adult) 2.0.  

Evidence-Based Prevention Strategies 

The NPIAP 2025 guidelines emphasize that most pressure injuries are preventable through systematic interventions: 

• Regular repositioning: Turn patients every 2 hours or 3 hours in bed and individualize frequency based on clinical assessment
• Support surfaces: Use appropriate pressure-redistribution mattresses and cushions for high-risk patients
• Skin care: Maintain clean, dry skin and manage incontinence promptly
• Nutritional support: Ensure adequate protein intake and hydration
• Friction reduction: Use proper transfer techniques, lifting devices, and soft silicone foam dressings to the sacrum and heels

Our Professional Commitment 

As nurses, we stand at the frontline of pressure injury prevention. This November 20, let's recommit vigilance in risk assessment, adherence to evidence-based protocols, and advocacy for adequate resources. Every skin assessment matters. Every repositioning schedule followed prevents harm. Every nutritional consultation could save a life. 

Remember: pressure injuries are not inevitable. They are preventable complications that demand our constant attention and best clinical judgment. Let's make every day a Pressure Injury Prevention Day. 

REFERENCES

The Agency of Healthcare Research and Quality. Pressure Ulcers. https://www.ahrq.gov/topics/pressure-ulcers.html  

National Pressure Injury Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. Pressure Injuries/Ulcers: Definition and Etiology. In: Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The International Guideline: Fourth Edition. Emily Haesler (Ed.). 2025. [cited: November 5, 2025]. Available from: https://internationalguideline.com.