RNOtherJournal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society2025

Skin Failure: Results of a Think Tank Hosted by the National Pressure Injury Advisory Panel.

Joyce Black, Jill Cox, Janet Cuddigan and 10 others

PMID 40994173

WHAT IT FOUND

Skin failure in critically ill cannot yet be separated from pressure injury: no distinct cause, mechanism, or biopsy findings are established.

Use it only after root cause analysis and exclusion of other skin diseases.

Key findings

01No distinct cause, pathophysiology, or histopathology separates non-pressure-related skin failure from pressure injury in critically ill patients.

02The proposed diagnosis should follow a root cause analysis showing standard preventive care was completed and other causes were excluded.

03Photographs alone will not diagnose non-pressure-related skin failure or separate it from pressure injury.

STILL TO COME

How it was doneWhat they foundWhat it means for RNs

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What it does not show

The participants were think tank members, not patients, so this is expert consensus rather than a clinical outcome study. The statements were not designed as practice guidelines. The paper says the research base is sparse, with no agreed definition, no distinct cause, no clear pathophysiology, and no described histopathology. It did not test a diagnostic tool or treatment. The literature summary included selected studies and reviews, not a new systematic review of all relevant evidence. Some intended expertise was missing because no American Geriatric Society representative could be found.

The easy way to misread this

Do not use skin failure as a proven separate diagnosis that excuses pressure injury prevention gaps. The think tank said it is not an excuse for substandard care and that no distinct cause, mechanism, or histopathology has been established.

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