What a prevention program is

A pressure injury prevention program in a nursing home is not a binder or a single in-service. It is a set of routines that make it likely the right thing happens for the right resident on every shift, including the weekend with two call-offs. What separates one building from another is whether the routines hold.

This guide is general education, not legal or compliance advice. Your policies, your medical director and current clinical guidelines govern the details.

Risk assessment that leads to action

Assess risk on admission, on the schedule your policy sets and whenever a resident’s condition changes: a hospital stay, a fall, a new infection, or a drop in intake or mobility. Most facilities use a validated tool such as the Braden Scale.

The total score matters less than the reasons behind it. A resident who scores low for moisture needs a different plan from one who scores low for mobility or nutrition. Read the subscales, then add clinical judgment for what the tool does not capture, such as an earlier pressure injury, poor circulation or contractures.

Skin checks, daily and weekly

Two layers of inspection work together.

  • Daily, by CNAs. Aides see skin during bathing, dressing and incontinence care. Give them a way to report anything new, such as a shower sheet, and make sure a nurse looks the same shift.
  • Weekly, by a licensed nurse. A documented head-to-toe check for every resident.

A skin assessment on admission gives both layers a baseline. Thank the aide who reports a red heel. In buildings where a report earns a sigh, the reports stop.

Core interventions to individualize

Every at-risk resident needs a plan drawn from the same short list.

  • Repositioning. A schedule based on the resident’s tolerance and skin response, including time in the chair.
  • Heels. Kept free of the mattress for residents who cannot move their legs.
  • Support surfaces. A mattress and chair cushion matched to risk, working and set correctly. See cushions and mattresses for pressure relief.
  • Moisture. A toileting or checking plan, gentle cleansing and skin protection. See our notes on incontinence and skin protection.
  • Nutrition and hydration. Dietitian review, weights and attention to untouched trays, because nutrition and healing are tied.
  • Friction and shear. Lift equipment and slide sheets instead of dragging.
  • Medical devices. Regular checks under oxygen tubing, splints, braces and catheters.

Care plans that match the person

A care plan that says “turn every two hours” for every resident is a template. Write what will be done for this resident, in terms an aide can act on, and put it where the aide will see it.

When a resident declines an intervention, the plan should say so and show what was offered instead. The record should show that the team explained the risk, looked for the reason and kept offering alternatives.

Roles, education and equipment

Name an owner for the program, usually the director of nursing, with the wound nurse running it day to day. Everyone else has a part.

  1. CNAs reposition, inspect and report.
  2. Floor nurses assess, respond to reports and carry out treatments.
  3. The wound nurse tracks at-risk residents and wounds and coaches staff.
  4. The dietitian and therapy team review referred residents promptly.
  5. The MDS nurse keeps assessments and care plans in line with what is found.
  6. Maintenance or central supply keeps mattresses, cushions and lifts in service.

Teach prevention at orientation and at regular intervals. Audit equipment regularly. A flat cushion or a mattress on the wrong setting undoes a good plan.

Track, review and learn

Keep a log of every pressure injury, marked as present on admission or acquired in the facility. Review it weekly with nursing leaders and bring the trends to your quality committee.

Review each new facility-acquired injury while memories are fresh. The aim is to fix the process, not to blame the last nurse on shift.

In general terms, regulators expect a facility to identify risk, put individualized interventions in place, carry them out consistently and revise the plan when it is not working.

Where a visiting wound clinician fits

Prevention is a facility program. A treating clinician who sees residents on facility wound rounds adds assessment and orders for existing wounds. Our page on pressure injury prevention describes how the two fit together.

Gateway arranges visits with partner clinicians for skilled nursing facilities in Greater St. Louis and the Metro East, with availability confirmed by location. Call 314-325-0126 or refer a resident.

Common questions

How often should pressure injury risk be reassessed in a nursing home?

On admission and readmission, at the intervals your policy sets and with any significant change in condition. Many facilities reassess more often in the first weeks after admission, when new residents are most vulnerable. A new score should prompt a look at whether the plan still fits.

Is turning every two hours right for every resident?

No single interval suits everyone. Two hours is a common starting point for residents in bed, but the right schedule depends on the support surface, the resident’s skin response, comfort, sleep and medical condition. Document the reasoning and adjust to what the skin shows.

What should a review of a new pressure injury cover?

Look at the most recent risk assessment, the care plan, repositioning and treatment records, intake and weights, the support surface, and any recent illness or change in mobility. Talk with the aides and nurses who cared for the resident. Decide what will change and assign it to a named person.

How do we keep agency and new staff in step with the program?

Give them a one-page summary on their first shift: how at-risk residents are identified, where turning and heel plans are kept, how to report a skin change and who to call. Unit managers should round on at-risk residents early in any shift staffed by people new to the building.

Related pages

Updated October 2026