Pressure Injury Prevention Quick Reference

Repositioning relieves sustained pressure over bony prominences — the primary mechanical cause of pressure injury. Pressure + time = tissue ischemia.

• Frequency: reposition at least every 2 hours for immobile patients in bed; every hour in a chair.
• 30-degree lateral positioning: avoid direct pressure on the greater trochanter (hip); tilt to 30° rather than 90° side-lying.
• Heels: keep heels fully offloaded using pillows or heel-offloading boots — place pillows under the calves, not under the heels.
• HOB elevation: keep the head of bed at or below 30° when clinically safe to reduce shear forces — obtain a respiratory order if elevation is required.
• Lifting vs. dragging: always lift — never drag — patients across surfaces. Use lift sheets or mechanical lifts to prevent friction and shear.
• Turn schedule: document each turn with position, time, and skin assessment — visible in chart to ensure continuity across shifts.

Common bony prominences at risk: sacrum/coccyx, heels, greater trochanters, ischial tuberosities, occiput, scapulae, lateral malleoli, medial knees.

Perform a full skin assessment on admission and at every repositioning opportunity. Early detection prevents progression.

• Inspect all bony prominences — sacrum, heels, occiput, elbows, hips, ankles at minimum.
• Blanchable erythema vs. non-blanchable: press on a red area for 3 seconds. If it blanches (turns white) and color returns, it is intact. If it does not blanch, suspect a Stage I pressure injury and act immediately.
• Assess under and around medical devices — NG tubes, oxygen masks, splints, casts, compression devices, and IV tubing all cause device-related pressure injuries.
• Darker skin tones: non-blanchable erythema may not be visible — assess for warmth, firmness, bogginess, or pain at the site as indicators.
• Document findings in objective language: location, size, color, presence of non-blanchable erythema, and any changes from prior assessment.

Moisture increases skin fragility and friction, significantly raising pressure injury risk. Moisture-related injury (incontinence-associated dermatitis) is not a pressure injury but increases susceptibility to one.

• Skin cleanser: use a pH-balanced, no-rinse cleanser — avoid harsh soap and vigorous scrubbing which disrupt the skin barrier.
• Moisture barrier: apply a barrier cream or film (zinc oxide, petrolatum-based, or dimethicone products) to perianal and perineal skin after each cleansing.
• Incontinence management: address the underlying cause; consider bladder training, scheduled toileting, and absorbent products — not as a substitute for skin care, but as a supplement.
• Diaphoresis: change linens and gowns promptly; use moisture-wicking under-pads when available.
• Wound drainage: contain and manage drainage from wounds to prevent peri-wound maceration.

Adequate nutrition is essential for tissue maintenance and repair. Malnutrition significantly increases pressure injury risk and impairs healing of existing injuries.

• Protein: adequate protein intake is the most critical macronutrient for tissue integrity and healing. Monitor albumin and prealbumin as markers of nutritional status.
• Hydration: ensure adequate fluid intake; dehydration impairs skin turgor, perfusion, and cellular function.
• Nutrition consult: refer at-risk or malnourished patients to a registered dietitian (RD) — consider enteral supplementation per provider order.
• Vitamins and minerals: Vitamin C and zinc support wound healing; supplement as directed when deficiency is present.
• Monitor oral intake: document percentage of meals eaten; report poor intake to the provider and care team.