Pressure injuries (PIs) are a significant health issue worldwide, and contribute substantially towards the economic burden in healthcare systems. This is primarily because PIs increase the length of hospital stays; and longer hospital stays also predict PI development. PIs are also used to measure the performance of health staff and facilities in a variety of settings. Inappropriate management of PIs can lead to further complications, necessitating an increase in resources in the hospital for assessment, monitoring and treatment. However, over time, challenges in regard to identifying, assessing and reporting PIs have proven to be problematic for a number of reasons. This paper explains the main challenges to PI assessment, and presents a series of best practice recommendations to rectify these challenges.