Approximately 1 in 10 hospitalized patients develops a pressure injury, making hospital-acquired pressure injuries (HAPIs) one of the most common and costly hospital-acquired conditions in the United States. As hospitals and health systems navigate the changing landscape of policies and best practices, pressure injury prevention must remain a top priority in patient care.
For example, the Centers for Medicare & Medicaid Services (CMS) currently requires hospitals to report Stage 3 and 4 HAPIs for quality reporting and reimbursement purposes. However, the recently introduced electronic Clinical Quality Measure (eCQM) Hospital Harm – Pressure Injury will expand reporting requirements to include Stage 2 pressure injuries.
While reporting Stage 2 pressure injuries is voluntary as of now, it will become mandatory in 2028. As a result, healthcare providers must prioritize more effective pressure injury prevention protocols to focus on patient compliance, avoid penalties, and achieve optimal reimbursement rates.
Early Detection and Prevention
One crucial aspect of pressure injury prevention is conducting comprehensive skin checks upon admission. Accurate staging of pressure injuries at this point is also vital. This process helps identify existing pressure injuries and ensures that hospitals are not unfairly penalized for conditions that existed prior to admission.
However, while proper skin checks and staging are essential first steps, they are only part of the solution. Hospitalized patients are at a higher risk for developing a pressure injury when they have a medical condition that prevents them from changing positions or moving. As a result, hospitals need access to effective tools and technologies that can help prevent HAPIs, including positioning aids that address the primary contributing factors of friction and shear, and the use of a support surface with high-specification reactive foam for immobile persons.
Revaluating Redistribution vs. Offloading
By investing in innovative pressure injury prevention solutions, hospitals can improve patient comfort and reduce their risk of HAPI-related penalties. However, one area of ongoing debate in pressure injury prevention is the use of redistribution versus offloading techniques. While both approaches have their merits in mitigating the risk of pressure injury, they employ different methodologies.
Redistribution involves spreading pressure across a broader area of the body, thereby reducing stress on any single point. This method focuses on creating a supportive and evenly distributed surface that minimizes localized pressure points. Conversely, offloading completely eliminates pressure from susceptible areas, such as the sacrum and heels, a technique that can be particularly effective for preventing HAPIs from occurring in the first place, or for patients with existing wounds.
The challenge lies in how offloading devices are engineered. Effective offloading should not inadvertently increase pressure in other areas, underscoring the need for a carefully balanced approach that incorporates redistribution and offloading in the design of optimal pressure injury prevention devices.
Industry guidelines from the National Pressure Injury Advisory Panel (NPIAP) and Wound, Ostomy and Continence Nurses Society (WOCN) reinforce this, including instruction such as to reposition patients in a way that offloading of pressure points and maximum redistribution of pressure are achieved, as well as utilizing offloading tools such as specialized support surfaces to redistribute pressure.
Unfortunately, commonly used support surfaces for the two most prevalent sites of pressure injury, the sacrum and heel, are not designed to manage risk through redistribution and offloading. Devices such as waffle mattresses do not truly offload a patient’s sacrum; they merely redistribute body weight elsewhere. Many foam wedges used for prevention may achieve repositioning but often do not fully redistribute pressure due to possible sacral contact over time.
Clinical evidence supporting consistent pressure redistribution by traditional heel off-loading devices such as “moon boots” is also limited. Some offloading strategies may reduce heel contact pressure, but research on their ability to redistribute pressure more broadly and to do so reliably is insufficient. Furthermore, multiple straps can create problematic pressure points, cause shear, and lead to ineffective positioning, making proper heel care more complicated than it should be.
On the other hand, modern solutions designed with specialized materials such as a memory foam-type surface feature immersion and envelopment technology, reducing pressure on vulnerable areas and evenly distributing weight. Innovative products like the HeelP.O.D. Pressure Offloading Device and ELEVATE Patient Positioners exemplify this balance.
ELEVATE effectively offloads the sacrum and contours to the patient’s body for optimal redistribution. The proprietary material grips the mattress and holds the patient securely in place, minimizing the need for frequent boosting—a leading cause of work-related musculoskeletal disorders in healthcare. This is particularly important as the cumulative weight a nurse may have to lift during an 8-hour shift is equal to 1.8 tons (or 9 tons per week)! The patient begins at 40° and maintains the 30° position, aligning with NPIAP-recommended guidelines.
HeelP.O.D. incorporates an open-air concept and effectively offloads or “floats” the foot. Inside HeelP.O.D. are four layers of a specialized memory foam-type material that provide comfort while redistributing pressure across the device to prevent issues with the Achilles tendon or calf. The unique design of the device provides full heel access and visualization, enabling continuous use during wound debridement, dressing changes, skin assessments, and range-of-motion therapy.
By understanding both principles and integrating them into HAPI prevention solutions, healthcare providers can ensure that patients receive the best possible care. With solutions that utilize memory foam-type and other innovative materials, like those seen in HeelP.O.D. and ELEVATE, pressure redistribution and offloading become more effective and patient-friendly. These products not only facilitate better patient outcomes but also enhance compliance and usability.