Understanding the Standard Turning Schedule
The universally accepted standard for preventing pressure ulcers in bedridden patients is to reposition them at least every two hours. This guideline, often referred to as the “Rule of Two,” has been a cornerstone of nursing care for decades. The purpose is to relieve continuous pressure on bony areas of the body, such as the hips, tailbone, and heels, to promote blood circulation and prevent tissue breakdown.
The Importance of Regular Repositioning
Regular turning and changing are vital not only for skin health but for a patient's overall well-being. Prolonged immobility can lead to several complications that frequent repositioning helps to mitigate.
- Prevents pressure injuries (bedsores): The primary reason for turning is to relieve pressure and prevent wounds that can lead to severe infections.
- Improves circulation: Shifting positions boosts blood flow throughout the body, which is essential for healthy skin and overall function.
- Enhances respiratory function: Regular position changes can help prevent fluid from accumulating in the lungs, reducing the risk of pneumonia.
- Maintains joint mobility: Moving a patient regularly helps prevent joint stiffness and contractures, which are permanent tightening of muscles, tendons, and skin.
- Reduces discomfort: Regular changes provide an opportunity to adjust pillows and linens, ensuring the patient's comfort.
Factors That Influence the Repositioning Schedule
While the two-hour rule is a reliable starting point, a bedridden person's individual needs can necessitate a more frequent or customized schedule. Caregivers should consult with a healthcare provider to create a personalized plan based on several factors.
Individualized Patient Repositioning Considerations
- Risk level: Patients with a higher risk of developing pressure ulcers, such as those with poor circulation, existing skin conditions, or specific health issues, may need to be turned more frequently, sometimes as often as every hour.
- Comfort and pain: If a patient is experiencing pain or discomfort, they may need to be repositioned more often. Restlessness can be a sign that a new position is needed.
- Incontinence: For bedridden individuals with incontinence, soiled briefs should be changed as soon as possible, rather than waiting for the two-hour mark. Moisture is a major risk factor for skin breakdown.
- Support surfaces: The type of mattress or cushion used can affect the schedule. Specialized pressure-relieving mattresses, such as low air loss or alternating pressure pads, may allow for slightly longer intervals between turns for some patients.
Comparison of Standard vs. High-Risk Repositioning
Feature | Standard Repositioning | High-Risk Repositioning |
---|---|---|
Frequency (Bed-Bound) | At least every 2 hours | As often as every 1 hour, or individualized |
Ideal Positions | Side-lying (30° tilt), supine (30° head elevation) | Side-lying (30° tilt), supine (30° head elevation) |
Supporting Devices | Standard pillows, foam wedges | Pressure-relieving mattresses, alternating pressure pads |
Skin Monitoring | At least once per shift | Frequent checks with every repositioning and change |
Goal | General prevention for most bed-bound individuals | Intensive prevention for patients with compromised skin or high risk |
Essential Steps for Changing and Repositioning
Proper technique is crucial for protecting both the patient and the caregiver. The process should be gentle to avoid shearing, which is the friction that can cause skin tears. A hospital bed with adjustable features can make this process safer and easier.
Step-by-step repositioning process
- Gather supplies: Always have fresh linens, pillows, barrier creams, and any other necessary items ready before starting.
- Use a draw sheet: A draw sheet, or a sheet folded under the patient from shoulders to knees, is a key tool for moving the patient without dragging their skin.
- Explain the process: Tell the patient what you are doing, even if they are non-verbal. This helps maintain dignity and minimizes startle reflexes.
- Elevate the bed: Raise the bed to a comfortable working height to prevent caregiver back strain.
- Turn gently: With a helper, use the draw sheet to lift and turn the patient. A 30-degree lateral incline is often recommended to take pressure off the hip bone.
- Use support pillows: Place pillows or foam wedges under the patient's back, between their knees and ankles, and under their arms to maintain the new position and prevent joint-on-joint pressure.
- Check for alignment: Ensure the patient's head, neck, and spine are aligned and that no limbs are trapped beneath their body.
Managing Incontinence
When managing incontinence, immediate changing is necessary, regardless of the turning schedule.
- Check frequently: For incontinent patients, frequent checks (every 2–3 hours) are necessary to ensure briefs or pads are not soiled.
- Use barrier cream: Apply a protective barrier cream to clean, dry skin to protect against moisture and irritation.
- Allow skin to air: Whenever possible, give the skin some time to air out before applying a new brief.
Conclusion
For a bedridden person, the frequency of being changed and repositioned is a critical component of their care plan. While the gold standard is to turn patients at least every two hours to prevent pressure ulcers, this schedule should be adapted to the individual's specific needs, risk factors, and comfort levels. For incontinent patients, changing must occur immediately when soiled. By following these guidelines and maintaining a consistent schedule, caregivers can significantly reduce the risk of complications and improve the patient's quality of life. Always consult with a healthcare professional to determine the most appropriate and safe schedule for your specific situation.