Minnesota Hospital Association

Quality & Patient Safety

Preventing Pressure Ulcers/injuries

Patients in the hospital are at risk of developing pressure ulcers/injuries, or bedsores, when their skin is exposed to unrelieved pressure. Pressure ulcers continue to be the most reported adverse health event. According to the Agency for Healthcare Research and Quality (AHRQ), 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.

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 the SAFE SKIN road map and toolkit, which provides hospitals with evidence-based resources to prevent pressure ulcers/injuries. MHA then launched the SAFE SKIN 2.0 road map in 2011 and SAFE SKIN 3.0 road map in 2015.

In 2017, experts from across the state came together to streamline MHA pressure ulcer/injury resources and created a tiered pressure ulcer/injury road map. This road map contains best practice recommendations for interdisciplinary team involvement, prevention in critical care and the operating room, as well as prevention of medical device-related pressure ulcers. 

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 resources 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 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

Operating room

Medical device-related pressure injury toolkit

The Minnesota Hospital Association (MHA) Prevention of Medical Device Related Pressure Injury (MDRPI) toolkit is designed to help hospitals and health systems implement best practice interventions to improve patient outcomes. This toolkit is designed to help staff ensure that the correct medical device is used appropriately to reduce the risk of pressure ulcer/injury development. Product examples within this document are not inclusive nor are intended as an endorsement of a specific product. 

Medically necessary

  • Review, select and stock medical devices based on the device’s ability to induce the least degree of damage from the forces of pressure and/or shear (NPUAP, EPUAP, PPPIA, 2014, p. 120).
  • Remove medical devices that are potential sources of pressure as soon as medically feasible (NPUAP, EPUAP, PPPIA , 2014, p. 122).
  • Provide staff education on device necessity and empower staff to discontinue device when it is no longer appropriate for the patient.

Resources and examples:

Device fit, selection and stabilization

  • Ensure that medical devices are correctly sized and fit appropriately to avoid excess pressure (NPUAP, EPUAP, PPPIA, 2014, p. 121).
  • Apply all medical devices following manufacturer’s specifications (NPUAP, 2014).
  • Ensure that medical devices are sufficiently secured to prevent dislodgement without creating additional pressure (NPUAP, EPUAP, PPPIA, 2014, p. 121).

Resources and examples:

Reposition, remove and rotate

  • Consider all patients with medical devices at risk for pressure injury (NPUAP, EPUAP, PPPIA, 2014, p. 119-120).
  • Remove devices (or reposition nonremovable devices) to inspect skin under and around the device at least twice daily, per manufacturers guidelines or in the presence of edema (NPUAP, EPUAP, PPPIA, 2014, p. 121).
  • Pain assessment is completed on pressure points with non-removeable devices.
  • Devices are repositioned when the patient is repositioned to ensure devices are not pulled, kinked or lodged under the patient or between skin folds (NPUAP, EPUAP, PPPIA, 2014, p. 121).
  • Provide education and notify provider in case device adjustment or modification is necessary.

Resources and examples:

Prophylactic dressing

  • Consider using a prophylactic dressing for preventing medical device-related pressure ulcers/injuries (PU/I), avoid excessive layering of prophylactic dressings that may increase pressure at the skin-device interface (NPUAP, EPUAP, PPPIA, 2014, p. 123).
  • When selecting prophylactic dressings consider (NPUAP, EPUAP, PPPIA, 2014, p. 124):
    • Ability of the dressing to manage moisture and microclimate, especially when used with a medical device that may be in contact with bodily fluids/drainage
    • Ease of application and removal
    • Ability to regularly assess skin condition
    • Thickness of the dressing under tightly fitting devices
    • Anatomical location of the medical device
    • Type/purpose of the medical device

Resources and examples:

Inspect and educate

  • Inspect the skin under and around medical devices at least twice daily, at least every 8-12 hours (NPUAP, EPUAP, PPPIA, 2014, p. 121).
  • Conduct more frequent (greater than twice daily) skin assessments at the skin-device interface in individuals vulnerable to fluid shifts and/or exhibiting signs of localized or generalized edema (NPUAP, EPUAP, PPPIA, 2014, p. 121).
  • Educate the patient and family with a medical device on how to perform skin assessments and risk of PU/I development (NPUAP, EPUAP, PPPIA, 2014, 122).

Resources and examples: