A triangulation approach was used to examine the reliability of the National Database of Nursing Quality Indicators pressure ulcer indicator that included direct observation of these wounds in hospitalized patients and web-based testing with and without accompanying wound descriptions. Overall κ coefficients for pressure ulcer identification, staging, and origin indicate moderate to near perfect reliability and suggest that web-based testing can estimate the reliability of pressure ulcer staging from direct observation. Nurse certification in wound care and wound descriptors improved reliability levels.