Pressure Injury Survey Guide

After Data Collection

Determine Avoidable vs Unavoidable Pressure Injuries

Established after the hospital-acquired pressure injury has been identified and processes of care have been evaluated.

Unavoidable means the individual developed a pressure injury even though the provider evaluated the individual’s clinical condition and pressure injury risk factors, defined and implemented interventions that are consistent with individual needs, goals, and recognized standards of practice, monitored and evaluated the impact of the interventions, and revised the approaches as appropriate.

Example questions to evaluate processes of care:

  • Was the patient’s skin assessed on admission?
  • Was patient risk assessed on admission, was the assessment accurate?
  • Was patient risk reassessed at the recommended frequency and were these risk reassessments accurate?
  • Did the program of pressure injury prevention consider individual needs, goals and recognized standards of practice?
  • Was a program of pressure injury prevention consistently applied
  • Was there documentation for any contraindication to the application of a pressure injury prevention intervention
  • Was there documentation of patient adherence to the pressure injury prevention interventions
  • Was there documentation of strategies to address patient nonadherence to the prevention intervention?

Some pressure injuries are unavoidable. Despite definitions published by CMS and NPUAP, there are no universally accepted criteria for determining whether a pressure injury was avoidable or unavoidable.1-3 For the purposes of NDNQI data collection, both avoidable and unavoidable pressure injuries will be considered pressure injuries until such criteria are developed.

The determination of avoidable versus unavoidable should be reviewed for quality improvement purposes to improve our understanding of the factors contributing to avoidability/unavoidability and to refine our pressure injury care.

  1. Black, J.M., et al. (2011). Pressure ulcers: avoidable or unavoidable? Results of the National Pressure Ulcer Advisory Panel Consensus Conference. Ostomy Wound Management, 57(2), 24-37.
  2. Edsberg, L. E., Langemo, D., Baharestani, M. M., Posthauer, M. E., & Goldberg, M. (2014). Unavoidable pressure injury: state of the science and consensus outcomes. Journal Of Wound, Ostomy, And Continence Nursing: Official Publication Of The Wound, Ostomy And Continence Nurses Society / WOCN, 41(4), 313-334. doi:10.1097/WON.0000000000000050
  3. 3. Pittman, J., Beeson, T., Terry, C., Dillon, J., Hampton, C., Kerley, D., . . . Tucker, J. (2016). Unavoidable Pressure Ulcers: Development and Testing of the Indiana University Health Pressure Ulcer Prevention Inventory. J Wound Ostomy Continence Nurs, 43(1), 32-38. doi:10.1097/won.0000000000000191