Why Pressure Injuries Persist and How High-Reliability, Tech-Enabled Prevention Can Make Zero a Reality
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For three decades, hospitals have run pressure injury prevention programs built on risk scores, visual skin checks, and prevention bundles. Rates should have fallen close to zero by now. Instead, severe reportable pressure injuries are projected to climb 58% between 2019 and 2026.
That gap between effort and outcome was the starting point for Dr. Rhonda Sullivan’s recent webinar, Zero Harm by Design. Dr. Sullivan, a certified wound care nurse with more than 30 years in harm reduction, reviewed 28 pressure injury prevention projects presented at a national wound care conference. Only 13 reported a calculable reduction in hospital-acquired pressure injuries, and just three achieved zero harm. The median reduction across all projects was 55.6%. Progress, but not elimination.
Dr. Sullivan’s diagnosis: the tools driving today’s standard of care are subjective by design. The Braden Scale, the most widely used risk assessment tool, shows only moderate predictive validity (78% sensitivity, 72% specificity in a review of nearly 50,000 patients), and its accuracy drops further in older adults, critical care patients, and darker skin tones. Visual skin assessment fares worse: it can only catch damage after it becomes visible, by which point tissue injury may already be underway beneath intact skin.
The alternative Dr. Sullivan presented centers on sub-epidermal moisture (SEM), a biological signal that can appear up to 10 days before a pressure injury becomes visible to the eye. Unlike risk scores, SEM measurement is objective and skin-tone agnostic. An elevated delta at a specific anatomical site tells clinicians exactly where tissue is under stress and whether an intervention is working, rather than estimating who might be vulnerable in general.
The data Dr. Sullivan shared from real-world implementations is worth nursing leaders’ attention. Across 34 care facilities, SEM-guided prevention drove a 90.5% reduction in pressure injuries. In acute care, 74% of facilities reported zero acquired pressure injuries. Across diverse settings, including facilities where up to 80% of patients had darker skin tones, 92.8% of SEM-guided implementations achieved complete elimination of hospital-acquired pressure injuries.
Dr. Sullivan was also direct about a misconception she’s heard repeated: that SEM findings can’t support present-on-admission documentation. She walked through the coding pathway in detail, including the applicable ICD-10-CM and PCS codes, and was unequivocal that the claim is false.
If your organization is still treating pressure injury reduction as the finish line rather than the starting point, this session is worth 40 minutes of your time. Watch the full webinar on demand to hear Dr. Sullivan’s complete case for redesigning prevention around objective biology rather than subjective judgment.