The new guideline changes less than its complexity suggests. Two wound care experts say the real work is turning it into protocols, workflows and data that bedside teams can act on.
The updated International Pressure Injury Guideline will not lower pressure injury rates on its own. Its value depends on whether each facility turns it into clear protocols, easy bedside workflows and objective data.
That was the central message of our September 29, 2026 webinar with Catherine (Cathy) Milne, an advanced practice wound, ostomy and continence (WOC) nurse with Connecticut Clinical Nursing Associates, and Elizabeth (Liz) Faust, who led inpatient WOC nursing at Tower Health for more than 12 years. Bruin Biometrics CEO Martin Burns moderated.
Translation is hard for three reasons. The fourth edition uses GRADE methodology, which reads differently from the “if X, do Y” guidelines nurses know. It launched as a living document, so sections changed after release. And it arrives as CMS prepares a pressure injury eCQM that will make hospital performance more visible next year.
The panel’s advice comes down to four moves:
1. Update protocols for the changes that matter
The mountain is shorter than it looks. Most updates refine practice rather than overturn it:
- Repositioning now has clearer guidance on who, when and how, not just whether.
- Technology gets more emphasis, from tools that check whether turns are effective to assessments of changes beneath the skin that visual inspection cannot see.
- Tube feeding is no longer recommended for pressure injury prevention.
- Specialty populations such as pediatrics and hospice get specific guidance.
- The update covers prevention; treatment guidance has not been comprehensively revised since 2019. Pressure injury researcher Janet Cuddigan also noted during the Q&A that the living-guideline model has ended, with no changes expected for five years. That gives facilities a stable target. Her suggested starting point: the quick reference guide at internationalguideline.com, with protocol reviews focused on the new interventions.
2. Make the case to leadership as patient safety, not evidence certainty
By Bruin Biometrics’ analysis, only one of the guideline’s 94 statements rests on moderate-certainty evidence, and none on high-certainty evidence. Even repositioning, standard practice for generations, falls below moderate.
That reflects ethics, not weak practice. Nobody will withhold a support surface from a malnourished, immobile patient to run a trial. “You just wouldn’t do that to somebody,” Milne said.
Faust’s advice for C-suite conversations: separate graded recommendations from good practice statements, and leave off the certainty ratings that invite skepticism. Frame the question clinicians already know the answer to: what happens if we don’t do it? Milne added that leaders should call it what it is, a patient safety issue.
Funding follows financial risk. Milne recalled that when CMS stopped paying for hospital-acquired pressure injuries in 2008, beds, cushions and seating services suddenly got funded. The eCQM could have the same effect.
3. Design workflows for the people doing the work
Certified nursing assistants deliver most prevention, yet the guideline rarely reaches them in usable form. Burns noted that fewer than 10,000 of roughly 4.1 million U.S. nurses hold wound certification. The job is to make the right thing the easy thing:
- Run a workflow analysis against the current recommendations.
- Update the EMR, and budget time for it.
- Build an interdisciplinary skin team: IT, physical therapy, nutrition, even maintenance for support surfaces.
- Choose technology that fits the workflow. Tools that don’t, Milne warned, create alarm fatigue.
- Faust called it a culture change. Skin sits low on the acute care priority list, yet clinicians are responsible for the patient’s head-to-toe health.
4. Measure objectively, in real time
“You can’t act upon what you don’t record or assess,” Faust said. One health system she analyzed had no single source of truth for hospital-acquired pressure injury data; teams counted differently for hospital harm, Magnet and NDNQI reporting. Agree on one definition, review incidents daily and trace each case back to what could have prevented it. Objective data supports SMART goals, team buy-in and a financial case leadership will fund.
What the panelists would change
Asked what they would do as “queen for a year,” Faust chose mandatory pressure injury education for every discipline, from physicians to nursing assistants. Milne worried that the guideline’s “where resources permit” qualifier will become an excuse for inaction and would fund technology in every institution.
Watch the full webinar recording. Then start your protocol review with the quick reference guide at internationalguideline.com.
Meet Your Speakers
Catherine T. Milne, MSN, APRN, ANP/ACNS-BC, CWOCN-AP, WOCNF
Advanced Practice Wound, Ostomy, Continence Nurse
Catherine Milne is an Advanced Practice Wound, Ostomy, and Continence (WOC) Nurse with Connecticut Clinical Nursing Associates. She provides hands-on clinical care across acute care, long-term care, home health, and outpatient settings. She is actively involved in clinical research, widely published in the WOC field, and a frequent lecturer at national and international conferences. She is the co-editor of two major wound textbooks and has authored numerous articles, and she serves as a clinical instructor at the Yale School of Nursing. Cathy has served as a Nurse Board Member of the Association for the Advancement of Wound Care (AAWC) and currently sits on the AAWC Education Committee. She is the founding President of the Coalition for At-Risk Skin (CARS) and a Fellow of the Wound, Ostomy, Continence Nurses Society®, inducted in 2024, and is the recipient of the 2026 John A. Boswick Award.
Elizabeth Faust, CWOCN-AP, CRNP, MBA
Experienced Wound Care Consultant
With over 16 years of experience in wound care, Elizabeth Faust, owner of Lizzie Wounds, LLC, provides evidence-based services to patients, providers, and organizations. She is President-Elect of The Save A Leg, Save A Life Foundation, a non-profit organization that promotes limb salvage and wound healing. She holds the credentials of CRNP (Certified Registered Nurse Practitioner) and CWOCN-AP (Certified Wound, Ostomy, and Continence Nurse-Advanced Practice). Her mission, and the mission of Lizzie Wounds, is to improve outcomes and quality of life for people with wounds and related conditions, and to advance the knowledge and practice of wound care.
Martin Burns
CEO, Bruin Biometrics, LLC
At Bruin Biometrics, Martin made that vision tangible. With the Provizio SEM Scanner and PIPPA platform, Martin and colleagues have proven that preventable harm can be stopped before it starts. That’s the joy for Martin: watching innovation dissolve a problem so completely it feels obvious in hindsight. An inventor on more than 500 global patents, Martin has co-authored publications on PI prevention and healthcare economics, presented internationally, and served as Chair of the Corporate Advisory Panel for the National Pressure Injury Advisory Panel. With a BA from the London School of Economics and an MBA from UCLA Anderson, Martin’s greatest insights come from listening—to patients, to nurses, and to the unspoken dynamics of care. For him, pressure injuries have no place in modern medicine.