Medical Research: Emerging Concepts and Applications Vol. 3

Pressure injury in intensive care is a clinically consequential, nursing-sensitive safety problem whose prevention depends on the reliability of many small processes performed repeatedly under conditions of physiological instability, immobility, device dependence and competing treatment priorities. Clinical nursing audit is therefore attractive as a quality-improvement mechanism, yet audit can become a documentation exercise if indicators are poorly specified, outcome rates are interpreted without case-mix or ascertainment context, or feedback is disconnected from action. This critical narrative review examines how clinical nursing audit can be designed and used to improve pressure injury prevention and management in adult intensive care. Literature published from 1 January 2006 to 14 June 2026 was identified through live searches of accessible scholarly sources and targeted citation searching; earlier foundational work was retained where conceptually necessary. Evidence was synthesised across pressure-injury epidemiology and risk, prevention interventions, measurement reliability, nursing-sensitive indicators, audit and feedback, implementation, and post-injury management. The synthesis indicates that audit is most defensible when it combines structure, process, outcome and contextual measures rather than relying on hospital-acquired pressure injury counts alone. High-value process measures include comprehensive risk assessment linked to action, serial skin and device assessment, individualised repositioning delivery, support-surface appropriateness, device offloading, nutrition assessment and timely escalation. Evidence for several individual preventive interventions remains low or very low certainty, particularly for fixed repositioning schedules, specific support-surface modes and nutritional supplementation; consequently, audit standards should distinguish evidence-based care processes from locally preferred products or rigid routines. Device-related, mucosal and prone-position pressure injuries require distinct surveillance because conventional staging and denominators can obscure their burden. Effective audit and feedback is likely to be iterative, timely, credible, team-level and action-oriented, with re-audit used to close the loop. Future work should test audit architectures themselves, including risk-adjusted measures, electronic data capture, human validation, implementation fidelity and patient-centred balancing outcomes.