Skin Integrity in Action: Hands-on Pressure Relief and Nutrition-Focused Teamwork

Course Description:

Explore practical strategies to prevent pressure injuries and promote optimal skin integrity across care settings. Clinicians will examine hands-on approaches to pressure redistribution, repositioning, moisture management, and early mobilization, along with the critical role of nutrition in supporting skin health and preventing wounds. Learn how interdisciplinary teamwork and guideline-informed practices can improve patient outcomes and reduce facility-acquired skin breakdown.

Course Objectives:

• Demonstrate evidence-based strategies for preventing pressure injuries and supporting optimal skin health.
• Describe effective strategies for working with multidisciplinary teams to establish and maintain repositioning schedules and nutrition care plans.

Key Takeaways:

• Current guidelines recommend promoting skin integrity as the goal of preventive pressure injury care.
• Effective protocolized pressure redistribution strategies impact pressure injury prevention.
• Moisture is a key risk factor for hospitalized patients and developing a plan to address how the skin is cleaned and protected is critical.
• Refer all individuals at risk for PIs and malnutrition to a dietitian for a full nutrition assessment.
• Dietitians, nurses, and wound care teams can work together within their scope to integrate best practices for PI prevention and management.

Related Questions:

• What are the most effective evidence-based strategies to prevent pressure injuries in hospitalized or immobile patients? 
  Evidence-based pressure injury prevention centers on systematic risk assessment (e.g., the Braden Scale), structured skin care to manage moisture, routine repositioning with pressure-redistribution surfaces, early mobilization, and prophylactic use of silicone foam dressings for high-risk areas such as the sacrum and heels. The use of standardized protocols, such as SPIPP-Adult 2.0, and adherence to international clinical practice guidelines have been shown to significantly reduce hospital-acquired pressure injuries. Multidisciplinary implementation is critical for achieving sustained outcomes.
  
• How do repositioning schedules, support surfaces, and positioning techniques work together to reduce pressure injury risk?
  Repositioning every 2-3 hours—or using frequent incremental micromovements for unstable patients—works best when paired with appropriate pressure redistributing mattresses or overlays. Proper positioning techniques, such as the 30-degree lateral position, heel offloading, and use of low-friction devices, reduce shear and localized pressure on bony prominences. When integrated into standardized workflows or supported by turn teams and wearable reminder technologies, these strategies are associated with meaningful reductions in pressure injury rates and caregiver injury.
• What role does nutrition play in pressure injury prevention and skin integrity, and when should a dietitian be consulted?
  Nutrition is a foundational component of skin integrity and pressure injury prevention, as inadequate energy, protein, fluid, and micronutrient intake impairs tissue tolerance and healing. Guidelines recommend nutrition risk screening on admission, early referral to a dietitian for patients who are malnourished or at risk, have decreased nutrient intake, are NPO for more than 48 hours, or have a stage 2 or greater pressure injury, and the provision of adequate calories (30–35 kcal/kg), protein (1.2–1.5 g/kg), hydration, and targeted supplementation when intake is insufficient. Dietitians play a key role in assessing nutrition status, integrating findings with skin assessments, and collaborating with nursing and wound care teams to optimize outcomes.