Hospital acquired pressure ulcers stage 3+ not present on admission (AHRQ PSI-3) is already a measure that looks at escalation or degradation of a skin integrity issue from the patient's level of well-being at admissions. The evidence is clear in the research that, without an intensive and almost specialized education in the recognition of a pressure ulcer stage 2 or lower, there is an inter-rater reliability issue which induces artifact into the measurement. Pressure injuries and skin integrity is an issue in hospitals that is still being addressed and most know the cost of failure to prevent skin degradation because it impacts them in the CMS HAC Prevention program as well as the HIIN which provides the enrolled hospitals with information on the cost of treatment. As a quality adviser for a number of years for hospitals and nursing homes across the state of Georgia, I have seen the rate of hospital acquired pressure ulcer decline drastically to the point that in hospitals, it is a rare event with diminishing returns on investment in additional prevention tools and strategies. Adding another measure in my view, will not have an improvement on patient care.