Hospital-acquired pressure injuries (HAPIs) are presumed to be preventable injuries that can have a substantial impact on the outcomes of acutely and critically ill patients. To minimize additional harm from HAPIs, most health care organizations have implemented evidence-based strategies to reduce the occurrence of HAPIs. Yet national organizations, such as the Center for Medicaid and Medicare Services, the National Pressure Ulcer Advisory Panel, and the Wound, Ostomy, and Continence Nurses Society, recognize that some HAPIs are unavoidable even if the patients are exposed to evidence-based prevention strategies. Predicting which patients will have HAPIs develop is a recognized research priority. Patients in whom unavoidable HAPIs develop are typically at higher risk for HAPIs, and preventative strategies are likely to be contraindicated or ineffective.

Determination of which patients are at risk for an unavoidable HAPI is limited by a lack of reliable and valid measures....

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