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The Standardized Pressure Injury Prevention Protocol for Improving Nursing Compliance With Best Practice Guidelines

Padula WV, Black JM | Journal of Clinical Nursing | 2018

A clinician places their hand on a patient's shoulder while resting in a Hillrom hospital bed.


Compliance with international best practice guidelines can effectively prevent most hospital-acquired pressure injuries (HAPIs) (Black et al., 2011; Padula et al., 2016) These guidelines include several nursing interventions that first were introduced in 1992 by the U.S. Agency for Healthcare Research & Quality (AHRQ), and have since been updated by the National Pressure Ulcer Advisory Panel (NPUAP) every 3–5 years (NPUAP, 2014; Panel on the Prediction and Prevention of Pressure Ulcers in Adults, 1992. AHCPR Publication No. 91-0047). Following admission, nurses should perform a daily skin check and risk assessment using a validated risk tool (Bergstrom, Braden, Laguzza, & Holman, 1987; Braden & Bergstrom, 1994). Patients determined to be high-risk receive additional measures: (a) repositioning every 2–4 hr; (b) managing skincare and incontinence; (c) improving nutrition; (d) using pressure-relieving support surfaces; and (e) reducing friction and shear (Agency for Healthcare Research and Quality, 2011; NPUAP, 2014). Many hospitals struggle to incorporate these guidelines into a daily routine given the intense amount of nursing time, costliness to implement, uncertain clinical effective-ness, and competing patient demands and hospital priorities.

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Care Settings: Acute Care

Clinical Focus: Pressure Injury Management

Content Type: Journal Articles