The purpose of this interprofessional quality improvement (QI) project was to reduce patient harm through the decrease of pressure injuries at a 150 bed southeastern children’s hospital. The Braden QD Scale was used across the children’s hospital to capture device-related pressure injury risk. The Braden QD scores of patients who had documented PIs over a 24 month period were reviewed and subsequently it was found that the scores did not align with a high-risk result per the screening tool. The scoring was then expanded to include Low-Risk, Moderate-Risk and High-Risk and guided interventions based on risk score were developed. Focused interventions were implemented in the Pediatric Cardiac Intensive Care Unit and Pediatric Intensive Care Unit to address device related PIs. Devices associated with increased PIs were identified as High-Risk and tagged with a #underpressure logo and a QR code that linked to interventions when scanned. Weekly skin rounds were added with clinical leadership and a CWOCN. Standardized communication protocols were developed including review of PI risk daily during multidisciplinary rounds and communication during charge nurse handoff each shift. For the extremely High-Risk patient population receiving extracorporeal membrane oxygenation (ECMO), an ECMO PI Prevention Bundle was developed and implemented. Data was collected and analyzed monthly. From FY20 to FY22 a reduction of 55% in HAPI rate per 1000 patient days in the PICU/PCICU was observed.