Note: The following content abbreviates Pressure Injury as PI.
On June 22, 2023, the National Pressure Injury Advisory Panel in the United States released the Standardized Pressure Injury Prevention Protocol version 2.0 (SPIPP 2.0) and welcomes industry peers for reference! The following content is an introduction to the protocol and its main checklist:
In the context of clinical guidelines, it is increasingly necessary to create a simple, operational version for clinical use, thus, on June 22, 2023, the National Pressure Injury Advisory Panel in Massachusetts released the second edition of the standardized pressure injury prevention protocol, abbreviated as “SPIPP” (pronounced S – PIP). SPIPP is a streamlined bedside prevention entry, with main content adapted from the 2019 Clinical Practice Guidelines for Pressure Injury Prevention and Management.
SPIPP 2.0 is aimed at individuals with limited mobility and severe conditions. The current or anticipated mobility of patients is considered an important risk factor in the SPIPP 2.0 checklist, which is also significant for perioperative patients. Moreover, since mild pressure injuries in individuals with darker skin tones may not be easily detected under insufficient lighting, SPIPP 2.0 emphasizes this aspect to raise awareness and promote its implementation in practice, enhancing protective measures.
SPIPP 2.0 provides clear and concise entries for managing skin cleanliness, moisture, and other aspects. The protocol specifically states that staff should proactively explain the risks of pressure injuries and prevention plans to patients and their families, which helps gain their active cooperation for more timely and adequate prevention outcomes.
According to expert panels from across the United States, the content validity index for SPIPP 2.0 is 0.93. Below are the main entries of the Standardized Pressure Injury Prevention Protocol version 2.0 (SPIPP 2.0):
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Standardized Pressure Injury Prevention Protocol Version 2.0 (SPIPP 2.0：Standardized Pressure Injury Prevention Protocol） |
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Assessment Items |
Completion Status |
Evaluation |
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Assess Pressure Injury (PI) risk factors for prevention guidance |
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Current or anticipated mobility issues |
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Use a structured risk assessment method upon admission(such as Braden or other validated risk assessment tools) |
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Reassess risk factors at each shift and when there are significant changes in condition |
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Explain pressure injury (PI) risks and prevention plans to patients/families |
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Other risk factors to consider: history of previous pressure injuries (PI), localized pain, diabetes, poor perfusion, vasopressors, hypoxia, increased temperature, advanced age, spinal cord injury, neuropathy, prolonged surgical/treatment duration >2hrs, severe illness, organ failure, sepsis, mechanical ventilation, medical devices, sedation, darker skin tones |
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Assess skin/tissue for signs of skin damage and pressure injuries (PI) |
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Assess skin upon admission and at each shift(comprehensive, visual, palpation) for redness, color changes, swelling, and temperature changes |
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Assess skin under medical devices at each shift |
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Check heels at each shift |
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For individuals with darker skin tones, ensure adequate lighting and moisture/to enhance visual inspection |
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Consider enhanced skin assessment methods–thermal infrared imaging, SEM skin color charts |
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Preventive skin care–manage humidity/incontinence |
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Clean after each incontinence event and use appropriate moisture barriers |
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Avoid using alkaline soaps/cleansers |
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For high-risk individuals, consider urine/fecal management systems |
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Use single-layer, breathable, and highly absorbent pads for incontinence |
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Consider using low-friction textiles |
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Use soft absorbent materials in skin folds when appropriate |
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Pressure Redistribution |
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For individuals who cannot move independently in bed, turn/reposition every2-3 hours, and consider frequent micro-adjustments unless contraindicated(Braden activity/mobility score ≤2) |
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For immobile individuals, use high-specification pressure-relieving mattresses(Braden activity/mobility score ≤2) |
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Use positioning aids to minimize friction/shear(pillows, wedges). Use turning/lifting devices(if available). Correct side-lying position with the upper leg positioned in front of the lower leg |
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Add local pressure-relieving protective pads or multilayer protective dressings in high-risk areas(i.e. sacrum, lower buttocks, or heels)(Braden activity/mobility score ≤2) |
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Use pressure-relieving cushions, heel pressure-relieving pads, or specialized heel boots to elevate heels(Braden sensory perception score ≤3) |
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Ensure adequate repositioning while side-lying(30 degrees). Position the upper leg forward and use a pillow between the legs to support the upper leg |
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When the overall condition of the individual is unstable, perform slow, gradual, frequent, small adjustments in positioning |
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For individuals who cannot adequately reposition themselves, when sitting, use pressure redistribution cushions |
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Sitting patients should change positions at least once every hour, and can also change the direction of weight-bearing to relieve pressure |
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Consult a physical therapist for an activity plan when appropriate(Braden activity/mobility score ≤2) |
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Consider prompting systems, pressure monitoring, and movement sensors |
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Implement early activity plans |
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Nutrition |
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Use validated tools for malnutrition screening upon admission |
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For individuals with existing malnutrition or at risk of malnutrition, reduced nutritional intake,NPO>48hrs or with2 or more stage pressure injuries (PI),(Braden nutrition score ≤2) consult a dietitian |
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Provide additional calories, protein, fluids, and nutritional supplements(i.e. multivitamins, arginine, glutamine, HMB) based on the nutritional care plan or as needed |
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Continue to regularly assess goals and consult a dietitian as needed |