Minnesota Hospital Association

Quality & Patient Safety

Preventing Pressure Ulcers

Patients in the hospital are at risk of developing pressure ulcers, or bedsores, if their skin is exposed to unrelieved pressure. Pressure ulcers are typically the most reported adverse health event. According to the Agency for Healthcare Research and Quality, each year more than 2.5 million people in the U.S. develop pressure ulcers. The injuries to the skin and underlying tissue are painful and increase risk for infection or other complications.

In addition to patients who cannot change position, the following circumstances increase the risk of a patient developing a pressure ulcer:

  • Wetness from continuous or periodic loss of bowel
  • Not eating or drinking enough
  • Reduced mental awareness or confusion and/or bladder control
  • Medical devices against the skin

Minnesota hospitals are hard at work to eliminate serious pressure ulcers for patients and great progress has been made. Since 2003, hospitals have been reporting stage III and stage IV pressure ulcers to the state. Beginning in 2007, hospitals also started reporting unstageable pressure ulcers.


In 2007, MHA initiated the Call to Action framework around skin safety, resulting in SAFE SKIN. SAFE SKIN provides hospitals with resources of best clinical practices to prevent pressure ulcers, a road map of best practices and a toolkit to implement the road map recommendations in their facilities. The SAFE SKIN road map is based on the Institute for Clinical Systems Improvement (ICSI) Skin Safety Protocol; Wound, Ostomy and Continence Nurses Society's (WOCN) Clinical Practice Guidelines; International Pressure Ulcer Guidelines; and goes a step further to incorporate learnings from Minnesota Adverse Health Events (AHE) reports since 2006.

Based on AHE findings, MHA launched SAFE SKIN 2.0 in 2011 and SAFE SKIN 3.0 in 2015, which makes best practice recommendations for the operating room, prevention of medical device-related pressure ulcers and patients in critical care. 

Download the Pressure Ulcer/Pressure Injury road map.

Safe Skin toolkit

The tool kit provides tools that hospitals can use to implement the road map recommendations in their facilities. Hospitals can copy, translate, distribute and present the following SAFE SKIN Tool Kit items as long as you reference the Minnesota Hospital Association as the source of this material. If the tool is hospital-specific, please also cite the hospital as a source. Product examples within this tool kit are not inclusive nor intended as endorsement of a specific product. 

Skin safety coordination and team approach

Accurate and concurrent reporting tools

Facility expectations and staff education tools

Patient and family engagement

Skin inspection and risk assessment

Minimize pressure, friction and shear


Incontinence and moisture

Medical devices

Device-related pressure ulcer posters  

Respiratory devices

Cervical collar devices

  • MHA cervical collar recommendations and guidance
  • Anti-embolism stocking (AES) devices

    Operating room