Pressure Injury Prevention

Clinically significant pressure damage can develop in as little as 2 hours on an immobile patient — yet nearly all pressure injuries are preventable. The interventions are simple, but the timing is everything.

Pressure injury prevention centers on eliminating or reducing sustained pressure, shear, friction, and moisture on vulnerable tissue. The foundation is structured repositioning: turn immobile patients every 2 hours in bed and offload weight every 15 minutes when seated in a chair. Use the 30-degree lateral position to keep the client off the sacrum and greater trochanters — the two highest-risk sites. Risk assessment drives the plan. The Braden Scale (scored 6–23) is the standard tool; a score of 18 or below signals increased risk, and lower scores demand more aggressive interventions. Six subscales — sensory perception, moisture, activity, mobility, nutrition, and friction/shear — each identify a modifiable risk factor. Nutrition is a commonly underestimated driver: inadequate protein and caloric intake impairs tissue tolerance. Albumin below 3.5 g/dL and prealbumin below 15 mg/dL flag nutritional risk. Keep skin clean and dry, apply moisture barriers for incontinence, use pressure-redistribution surfaces (not "pressure-relieving" — nothing eliminates pressure entirely), float heels off the bed with pillows, and avoid elevating the head of bed above 30 degrees for prolonged periods to minimize sacral shear. Never massage reddened or bony prominences — this damages fragile capillaries.

Key Distinctions

Don't confuse pressure redistribution devices (spread pressure over a larger area) with positioning schedules (eliminate sustained pressure through turning) — the device does not replace repositioning. Students think a specialty mattress means they can skip the 2-hour turn; it doesn't. A Braden score is inversely scaled: lower number equals higher risk — the opposite of what most students assume on first encounter.

Clinical Pearl

Braden is backward — low score, high risk. Think of it like a bank account: the lower the number, the less reserve the skin has to withstand pressure.