Pressure Injury
A pressure injury (formerly pressure ulcer or decubitus ulcer) is localized skin and soft tissue damage over a bony prominence caused by pressure, shear, or friction — staged 1 through 4 plus unstageable and deep tissue injury — with hospital-acquired Stage 3, 4, and unstageable injuries classified as HACs with no Medicare payment.
What is a Pressure Injury?
Pressure injuries are classified using the National Pressure Injury Advisory Panel (NPIAP) staging system: Stage 1 (non-blanchable erythema of intact skin — redness that does not fade when pressed), Stage 2 (partial-thickness skin loss with exposed dermis — shallow open ulcer or intact/ruptured serum-filled blister), Stage 3 (full-thickness skin loss with visible subcutaneous fat — no bone, tendon, or muscle exposed), Stage 4 (full-thickness tissue loss with visible bone, tendon, or muscle), Unstageable (full-thickness tissue loss covered by slough or eschar that cannot be removed to assess depth), and Deep Tissue Injury (DTI — persistent non-blanchable deep red, maroon, or purple discoloration indicating soft tissue damage beneath intact skin). CMS's HAC non-payment policy applies to hospital-acquired Stage 3, Stage 4, and unstageable pressure injuries — Medicare will not pay for additional DRG weight attributable to these injuries if they were not Present on Admission (POA). AHRQ estimates the average treatment cost for a Stage 4 pressure injury at $129,248. Prevention relies on the Braden Scale (score ≤18 = at risk; lower scores indicate greater risk), repositioning every two hours, pressure-redistributing support surfaces, incontinence management, and nutritional assessment. HAPI (Hospital-Acquired Pressure Injury) rate per 1,000 patient days is the primary tracking metric; POA documentation accuracy determines whether an injury counts as hospital-acquired.
Why It Matters for Healthcare Analytics
Hospital-acquired Stage 3 and 4 pressure injuries trigger HAC non-payment, contribute to the HAC Reduction Program score that affects all Medicare DRG payments, and represent an average treatment cost exceeding $129,000 each. POA documentation accuracy is critical: a pressure injury that was present on admission but not documented as POA becomes an apparent HAPI, inflating the hospital's reported rate and HAC score without an actual quality failure.
How Vizier Tracks Pressure Injuries
Upload your quality and clinical data and ask "What is our HAPI rate per 1,000 patient days by stage and unit this quarter, and what percentage of patients at Braden score ≤18 had a completed prevention protocol?" — Vizier calculates HAPI rates, flags POA documentation gaps, and identifies units where Braden assessment and prevention compliance is lowest.