How do you prove a pressure injury is unavoidable?

In 2010, the National Pressure Ulcer Advisory Panel (NPUAP) reached consensus that unavoidable pressure injuries may develop in residents who are: hemodynamically unstable, terminally ill, have certain medical devices in place and are nonadherent with repositioning and artificial nutrition.

Although the panel agreed that certain situations can lead to an unavoidable pressure injury, it also emphasized the facility should provide pressure injury prevention. 

All residents should be assessed for pressure injury risk factors. Although the Braden Scale for predicting pressure injury risk is a good place to start, remember to assess for additional risk factors to ensure your assessment is comprehensive. These factors include diagnoses such as a terminal illness, hemodialysis, medications such as steroids and nonadherence to the plan of care. 

Base the plan of care on the results of your assessment, with the goal of modifying, stabilizing or eliminating the risk factors. Ensure interventions correlate with identified risk factors. For example, if the resident is immobile, then appropriate correlating interventions might be a pressure redistribution mattress and wheelchair cushion, a turning and repositioning schedule and heel lift devices. 

Nursing assistant assignment sheets should clearly reflect the interventions they should be providing. 

At scheduled care conferences, and with any significant changes in the resident’s condition, complete a new risk assessment. 

Overall, your goal is to prove you assessed for risk factors and implemented a plan of care based on the assessment but — despite your best efforts — the resident developed a pressure injury.