Pressure injury prevention strategies: Refocus on the basics to improve outcomes

Go beyond COVID-19 by championing support of evidence-based best practices.

Pressure injuries are painful and take a toll on a patient’s quality of life. For healthcare organizations, treating pressure injuries is costly in terms of both product and labor. Many pressure injuries are preventable, but when the pandemic turned everything upside down, you had to quickly shift gears—and goals. Some of your skin health initiatives may have been put on pause so staff could focus on caring for critically ill patients. Clinical experts called it a “fatigue of crisis.”

Now, as the fog of COVID-19 begins to lift in the US, it’s time to reinforce tools and strategies to prevent pressure injuries and create a culture of prevention.

Promote evidence-based best practices focused on prevention

There’s a distinction between evidence-based practice (EBP) and best practice—EBP is generally research-based, while best practice is more experience-based. However, when you combine them, you get the best of both worlds.

Evidence-based best practices make up the foundation of the National Pressure Injury Advisory Panel (NPIAP) clinical practice guidelines. Supporting NPIAP guidelines with a comprehensive solution to skin health helps you standardize prevention protocols across units, from frontline staff on up.

“A lot of times, bedside nurses are the worker bees. They innately do what’s best or what they think is best,” says Joanne Labiak, MSN, CRNP, CWOCN, CWS, DAPWCA, owner of Certified Wound Care Specialists, LLC, and a Medline consultant. “But it’s important to have guidance, so everybody is doing what’s best. That’s the philosophy of evidence-based best practices.”

Access the full NPIAP guidelines, a quick reference booklet and other resources here.

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Empower staff to protect skin through education and training

During the height of the COVID-19 crisis, education was challenging. At first, everything that was planned in person was canceled, from educational presentations to product demonstration fairs and workshops. Virtual education and training soon became the norm and worked surprisingly well.

It’s clear now that staff education can happen no matter what the circumstance. So how do you continue to make prevention education a top priority? Here are some dos and don’ts:

  • Do encourage the “why.” “Nurses have to understand the why, not just the what or the how,” says Patricia Turner BSN, RN, CWOCN, CWS, Medline Director of Clinical Resources, Skin Health-Acute Care. “Why is turning and repositioning so important, why would I put on a sacral dressing, why am I going to get a patient on a support surface. Knowledge is empowerment.”
  • Don’t reinvent the wheel. Use a turnkey educational program to create a Skin Champion team that helps encourage effective, systemwide pressure injury prevention.
  • Do make it fun. How about some “potty talk”? Yes, that’s what one of the Medline Skin Health Advisory Board members calls the educational reminders they hang in bathroom stalls. “When the nurses go into the bathroom, there will be at least 20 seconds where they’ll be staring at the wall,” she says. “So, we took advantage of that real estate.” They also make it humorous and memorable. Like the analogy of applying a skin barrier cream “like painting a child’s face” instead of “frosting a cupcake.”
  • Don’t do it alone. Consider partnering with another clinical expert to help you and your team identify gaps and opportunities. An on-site or virtual Skin Health assessment provides customized recommendations and ongoing support.
  • Do use a variety of learning resources. There are amazing digital resources, including online learning opportunities, but sometimes to-the-point printed material is handy too, like a pressure injury staging poster. One Medline Skin Health Advisory Board member chooses a monthly pressure injury prevention topic that’s discussed in huddles. Then, based on challenges nurses have at the bedside, she creates a one-page booklet with tips nurses can refer back to.
  • Do use simple decision trees. Algorithms help make complicated prevention strategies easier. For example, check out this guide to determining the right heel protection.

Support prevention strategies with a system of products

A successful pressure injury prevention initiative includes evidence-based products that support best practices. Selecting products that work together makes it easier to know what to use when. “Clinicians and physicians sometimes mix and match products, but they’re not tested to be used that way,” Labiak notes. On the other hand, she explains, a system of products pulls everything together, from education to utilization.

Dispel 4 myths of pressure injury prevention

Myth 1: Apply a sacral dressing and your job is done. In fact, it’s not a practice that should be viewed as an end-all-be-all. National Pressure Injury Advisory Panel (NPIAP) clinical guidelines do recommend at-risk individuals receive a soft silicone multi-layered foam dressing, but in conjunction with other prevention measures1. Studies show that including this practice as part of a skin care bundle can reduce pressure injury incidence.

Myth 2: Turn patients every two hours. This previous turning and repositioning protocol no longer applies. According to the updated NPIAP 2019 guidelines, the frequency should be determined on an individual basis, depending on activity levels and the person’s ability to reposition themselves.1 In addition, be sure you’re using the right support surfaces, and consider the following characteristics of each individual:

  • Skin and tissue tolerance
  • General medical condition
  • Overall treatment objectives
  • Comfort and pain

Myth 3: A little is good, a lot is better. Sounds logical, but that’s not usually the case. It’s important to follow the product application instructions, because sometimes over-applying can cause damage. For instance, excessive barrier products can crack, which breaks the seal and allows moisture in.2 It’s also inefficient and can unnecessarily drive up your cost of skin care.

Myth 4: CNAs are strictly task oriented. Think about what a certified nursing assistant does every day. They interact with patients and residents typically more than any other caregiver. They get to know the people they care for, and a lot of that care is personal. “Oftentimes, I’ll hear aides use the word ‘my’—‘my residents,’ ‘my people,’” says Joanne Labiak, MSN, CRNP, CWOCN, CWS, DAPWCA, owner of Certified Wound Care Specialists, LLC, and a Medline consultant. “There is this personal accountability. They see it as more than just a job,” she says. That’s why it’s important to truly rely on your CNAs and educate them to feel empowered to use the right products and best practices. Read about our targeted Skin Matters program, specifically for CNAs.

Key takeaway

We understand that the pandemic has posed challenges for your skin and wound care in ways you couldn’t have predicted. We also know that you want to refocus on preventing pressure injuries. A good place to start is with the basics of evidence-based best practices to guide you, education and training to keep prevention top of mind, and a system of products that works together to promote best practices and reinforce the education.

More insights on helping to prevent pressure injuries:
How to prevent skin breakdown: why you need a holistic approach
Request a free Skin Health assessment
Tackle pressure injuries from the bottom up with the right support surfaces
Watch the webinar: Building a pressure injury prevention program that works


  1. National Pressure Injury Advisory Panel, Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline 2019, pages 89, 117
  2. Fletcher, J. (2015). Appropriate selection and use of barrier creams and films. Wound Essentials, 10(2), 64–68. Available at