Standard Repositioning Guidelines
For most bedridden patients, the standard and widely accepted guideline is to change their position at least every two hours. This consistent schedule helps to prevent pressure ulcers, commonly known as bedsores, by redistributing weight and relieving pressure on bony areas such as the hips, tailbone, and heels. Regular turning improves blood flow to the skin, which is essential for maintaining tissue health. During repositioning, caregivers should perform a quick skin check for any signs of redness, which could indicate a developing pressure injury.
Factors that Influence Repositioning Frequency
While the every-two-hour rule is a general benchmark, a patient's individual care plan should dictate the precise frequency. Several factors can increase a patient's risk of developing pressure injuries, requiring more frequent repositioning. For example, patients with poor circulation, significant weight loss, or existing wounds may need to be moved more often.
High-Risk Patients
For individuals with a higher-than-average risk of developing pressure ulcers, repositioning may be necessary as often as every hour. This applies to patients with limited mobility, poor nutrition, or significant underlying health issues. Caregivers should consult with a healthcare professional to determine the appropriate schedule for these patients. A patient's comfort level and restlessness can also be an indicator that they need to be repositioned sooner.
Use of Pressure-Relieving Devices
The type of mattress or support surface can also affect the required turning frequency. Specialized beds, such as alternating pressure air mattresses or high-density foam mattresses, are designed to redistribute pressure automatically. For patients using these advanced devices, studies have shown that turning can sometimes be extended to intervals of four or even six hours. This not only frees up caregiver time but can also result in fewer patient awakenings during the night, improving sleep quality. However, even with these devices, diligent monitoring is still required.
Comparison Table: Repositioning Intervals
To help illustrate how different factors influence repositioning needs, the following table provides a comparison of recommended turning intervals.
| Patient Condition | Mattress Type | Repositioning Interval | Key Considerations |
|---|---|---|---|
| Standard Risk | Standard hospital mattress | Every 2 hours | Routine prevention for most bedridden patients. |
| High Risk (e.g., poor circulation, existing sores) | Standard hospital mattress | Every 1 hour | Requires more vigilant monitoring; prioritize shorter intervals. |
| Standard Risk | Pressure-relieving (e.g., foam) | Every 4 to 6 hours | Allows longer intervals but still needs consistent checks. |
| High Risk | Alternating pressure air mattress | Potentially longer than 2 hours | The device assists in pressure redistribution, but individual needs vary. |
Safe and Effective Repositioning Techniques
Proper technique is crucial for both the patient's safety and the caregiver's well-being. Using a drawsheet is a standard method that reduces friction and shear on the patient's skin, which can contribute to pressure injury formation.
- Explain the process: Before starting, always inform the patient what you are about to do, even if they appear unconscious.
- Use proper body mechanics: Adjust the bed to a comfortable height to avoid straining your back. Stand close to the bed, with feet shoulder-width apart, and use your leg muscles to pull or push, not your back.
- Use a drawsheet: Place a folded sheet under the patient, spanning from their shoulders to their knees. This allows you to roll or pull the patient gently instead of dragging them.
- Position with pillows: After turning the patient, use pillows or foam wedges to support their new position. For example, place a pillow between the knees and ankles to prevent them from rubbing together and prop another pillow behind their back. The “Rule of 30” technique suggests tilting the hips and shoulders at a 30-degree angle to relieve pressure.
The Importance of Skin Care and Monitoring
In addition to repositioning, a comprehensive care plan includes daily skin checks and proper hygiene. Excess moisture from sweat or incontinence is a key risk factor for skin breakdown and pressure sores. Keeping the patient's skin clean and dry with mild soap and moisturizers is vital. Caregivers should pay close attention to high-risk areas such as the back, hips, tailbone, and heels for any signs of redness, blisters, or broken skin. Early detection allows for prompt action and helps prevent the progression of a pressure injury to a more severe stage.
Conclusion
While a general recommendation is to reposition a bedridden patient every two hours, the definitive answer to how many hours do you change a bedridden patient is that it depends on the individual. Caregivers must create an individualized turning schedule based on the patient's risk factors, general health, skin condition, and the type of support surfaces being used. Consistent and proper repositioning, combined with diligent skin care, is the most effective strategy for preventing painful and dangerous pressure injuries.
Visit MedlinePlus for additional information on turning patients in bed.
