01/29/2026
Survey Tip of the Week: Survey Tip of the Week: Pressure Redistribution
Pressure injury survey deficiencies commonly arise when pressure redistribution interventions are not in place, have lost effectiveness due to age or condition, or are not reevaluated as clinical needs change. According to the State Operations Manual Appendix PP, pressure redistribution refers to the ability to distribute a load over a surface or contact area by shifting pressure from one area to another. This concept incorporates both pressure reduction and pressure relief and requires attention to all affected areas of the body. Surveyors expect facilities to demonstrate that pressure redistribution strategies are thoughtfully selected and consistently implemented based on the residents’ individual needs.
Appropriate support surfaces or devices should be chosen by matching the device’s potential therapeutic benefit with the resident’s specific situation, such as the presence of multiple injuries, limited turning surfaces, or the ability to maintain position. The effectiveness of pressure redistribution devices including gel mattresses, air-fluidized mattresses, and low-loss air mattresses depends on the resident’s level of risk, the resident’s response to the product, and the characteristics and condition of the device itself. Improper use may render these devices ineffective. For example, an overinflated overlay or one that “bottoms out,” leaving less than one inch between the resident and the support material, is unlikely to reduce pressure risk. Devices are most effective when used in accordance with manufacturer instructions and evaluated on an ongoing basis.
Surveyors consider whether static or dynamic pressure redistribution surfaces are appropriate for the resident’s condition. Static devices may be indicated for residents at risk for pressure ulcer/pressure injury (PU/PI) development or delayed healing. While specialized cushions or surfaces may extend sitting time, they do not eliminate the need for routine repositioning and skin assessments. Dynamic pressure reduction surfaces may be helpful when a resident cannot change positions without bearing weight on a PU/PI, when a static surface becomes fully compressed, or when a PU/PI is not healing as expected and pressure is contributing to delayed healing.
Special attention is required for high-risk areas such as the heels and elbows, which have limited surface area and are difficult to offload. Pillows that support the entire lower leg may effectively elevate the heel when clinically appropriate, while donut-type cushions are not recommended. Residents with severe flexion contractures may also require additional interventions to reduce pressure on bony prominences and prevent skin-to-skin breakdown.
Surveyors will review facility policies and procedures to determine whether expectations for selecting, using, monitoring, and reassessing pressure redistribution surfaces are clearly outlined and followed in practice. They will also evaluate whether staff are trained on and able to access manufacturer guidance to ensure equipment is set up, maintained, and used as intended.
