A nurse is caring for an 82-year-old patient who has been bedridden for 2 weeks following hip fracture surgery and has developed a stage 3 pressure injury on the sacrum measuring 4 cm × 3 cm with visible subcutaneous tissue and moderate exudate. Which nursing intervention should be the highest priority to prevent further tissue damage and promote healing?

For an immobile patient with a stage 3 sacral pressure injury, the primary intervention is strict pressure avoidance. Implement a documented turning schedule every 2 hours, alternating between supine, left lateral, and right lateral positions. Use a 30-degree tilted lateral position rather than a 90-degree side-lying position to reduce trochanteric pressure. Offload the sacrum completely when supine by using pillows or wedges.

Integrate a high-specification reactive foam or alternating pressure air mattress as a pressure-redistributing surface. Assess the wound for signs of infection, tunneling, or undermining during each dressing change. Select a dressing that maintains a moist wound environment while managing moderate exudate, such as a foam or alginate dressing, avoiding cytotoxic agents like hydrogen peroxide.

Optimize systemic factors to support healing: ensure adequate protein and calorie intake, monitor serum albumin and prealbumin, and manage pain to facilitate repositioning. Document wound dimensions, exudate characteristics, and periwound skin condition weekly to track progress.