How often should you reposition a bed-bound resident?

According to the CDC, millions of Americans develop pressure ulcers every year. Understanding how often should you reposition a bed-bound resident is paramount for preventing these painful and dangerous skin conditions, ensuring proper circulation, and maintaining overall health.

Quick Summary

A bed-bound resident should typically be repositioned at least every two hours, but this standard guideline requires personalization based on the individual's specific health needs, skin condition, and risk factors. A customized turning schedule is the best practice for preventing complications like pressure ulcers and poor circulation.

Key Points

• Frequency varies: The standard is every two hours, but this should be customized based on individual risk factors, health, and skin condition.

• Personalization is key: High-risk residents with conditions like poor circulation or diabetes may need repositioning more frequently, possibly every hour.

• Use proper technique: Always lift rather than drag the resident to prevent damaging shear forces on the skin. Use draw sheets and pads to assist.

• Monitor the skin: Regularly check bony prominences for persistent redness, warmth, or other changes, which are early signs of pressure ulcers.

• Use supportive devices: Specialized mattresses, overlays, pillows, and foam wedges can help redistribute pressure and increase comfort.

• Document every turn: Keep a turning schedule chart to ensure consistency among caregivers and track the resident's positioning.

Understanding the Risks of Immobility

Staying in one position for extended periods, known as immobility, presents significant health risks for bed-bound individuals. Consistent pressure on bony areas, such as the hips, tailbone, shoulders, and heels, reduces blood flow to the skin and underlying tissues. This can lead to the formation of pressure ulcers, commonly called bedsores. Beyond bedsores, prolonged immobility can cause a host of other issues:

• Compromised Circulation: Poor blood flow can increase the risk of blood clots and weaken the skin.
• Respiratory Complications: Without regular movement, fluids can accumulate in the lungs, increasing the risk of pneumonia.
• Joint Contractures: Joints can become stiff and frozen in position, leading to pain and reduced mobility.
• Muscle Atrophy: Disuse causes muscles to weaken and waste away.

Regular and consistent repositioning is the single most effective preventive measure against these complications, making it a critical task for all caregivers.

The Standard Guideline: The Two-Hour Rule

For most bed-bound residents, the widely accepted standard of care is to reposition them at least every two hours. This timeframe is scientifically supported as it is generally sufficient to relieve pressure and restore blood flow to vulnerable areas before significant tissue damage occurs. However, it is crucial to recognize that this is a starting point, not a rigid rule for all individuals. Personalization is key.

Factors That Influence Repositioning Frequency

• Skin Condition: Individuals with a history of pressure ulcers or fragile, pale, or discolored skin may need more frequent repositioning. Regular skin checks are essential to spot early warning signs like persistent redness that doesn't fade after pressure is relieved.
• Individual Risk Factors: Patients with conditions like diabetes, poor circulation, malnutrition, or incontinence are at a higher risk of developing pressure ulcers and may require repositioning more frequently, sometimes every hour.
• Mobility Level: Some residents have limited mobility and can assist with movement, while others are completely immobile. The level of independence affects how often and what type of assistance is needed.
• Support Surfaces: Using a specialized pressure-redistributing mattress, overlay, or cushion can extend the time between turns for some individuals, though it never eliminates the need for repositioning.
• Overall Health and Treatment Goals: A person's overall medical condition, including pain level and treatment plan, will influence the schedule. Critically ill patients, for example, may require a highly customized and frequent turning protocol.

Proper Techniques for Repositioning

Effective repositioning requires proper technique to ensure both the resident's safety and the caregiver's well-being. Using the right tools and body mechanics reduces the risk of injury for everyone involved. Proper communication is also vital; always explain what you are doing, even if the resident is non-responsive.

Repositioning in Bed

1. Preparation: Lock the bed wheels and raise the bed to a comfortable working height to protect your back. Gather necessary pillows, wedges, and a draw sheet.
2. Move the Resident: Using a draw sheet placed under the resident, gently slide them to one side of the bed. This prevents the friction and shear that can damage skin.
3. Turn the Resident: Roll the resident onto their side, using pillows or foam wedges to support their back, hips, and limbs. Never place a person directly on a hip bone.
4. The Rule of 30: When positioning on the side, ensure the resident is tilted at a 30-degree angle, not a full 90 degrees. This prevents concentrated pressure on the hip.
5. Head and Limbs: Ensure the head is properly aligned with the spine and that no limbs are resting directly on top of each other. Use pillows to pad knees and ankles.
6. Floating Heels: Place a pillow under the calves to keep the heels elevated off the mattress, as heels are a high-risk area for bedsores.
7. Document and Communicate: Record the time and position of each turn on a chart or log. This ensures consistency, especially among multiple caregivers.

Repositioning in a Chair

For bed-bound residents who also spend time in a chair or wheelchair, repositioning should occur even more frequently—at least every hour. Weight shifts should be encouraged every 15 minutes, if the person is able.

Comparison of Repositioning Schedules

Resident Risk Profile	Recommended Frequency	Key Considerations
Low-Risk	Every 2 hours	Regular skin monitoring, adequate nutrition, and standard positioning techniques.
Moderate-Risk	Every 1-2 hours	Increased vigilance, potentially use of pressure-reducing mattress, and frequent skin assessments.
High-Risk	Every hour or more	Specialized support surfaces (e.g., low air-loss mattress), specialized nutritional plan, and meticulous skin care.
Seated	At least every hour	Encourage weight shifts every 15 minutes if possible; use pressure-relieving cushions.

Advanced Equipment for Pressure Relief

In addition to manual repositioning, caregivers can use specialized equipment to aid in pressure management:

• Low Air-Loss Mattresses: These mattresses use air cells that inflate and deflate, constantly changing the pressure points on the body.
• Fluidized Beds: Beds containing silicone-coated beads that become fluid when air is pumped through them, offering superior pressure distribution.
• Specialized Wedges and Pillows: Foam wedges and other positioning aids provide stable support to maintain proper positioning and offload pressure from bony areas.
• Draw Sheets and Slide Sheets: These tools are crucial for lifting and moving a resident without causing friction or shear, which can tear delicate skin.

Nighttime Repositioning

Maintaining a consistent repositioning schedule at night can be challenging but is non-negotiable for high-risk residents. While the standard two-hour rule is ideal, some individuals on specialized pressure-relieving mattresses may tolerate longer intervals. Caregivers should consult with a healthcare professional to determine the safest nighttime schedule. For all residents, a bedside turning chart and a reminder system can be invaluable tools.

Conclusion

For a bed-bound resident, understanding how often you should reposition a bed-bound resident is the difference between proactive care and potentially life-threatening complications. While the two-hour standard is a reliable starting point, a truly effective care plan involves a personalized approach based on a thorough assessment of the individual's risk factors. By combining frequent, proper repositioning techniques with supportive equipment and vigilant skin care, caregivers can significantly enhance the resident's comfort, dignity, and overall health. For further guidance on preventing and managing pressure ulcers, consult authoritative sources such as the National Pressure Injury Advisory Panel.

Frequently Asked Questions

How do you know if a bed-bound resident needs to be repositioned more often?

Watch for early signs of pressure injury, such as persistent redness or discoloration on bony areas like the tailbone, hips, and heels. If the skin is non-blanchable (the redness doesn't fade when you press on it), it indicates damage and requires more frequent repositioning and medical consultation.

What is the 'Rule of 30' for repositioning?

The 'Rule of 30' involves two main principles: first, keep the head of the bed elevated no more than 30 degrees to prevent sliding and skin shearing. Second, when side-lying, position the resident at a 30-degree lateral incline using pillows or wedges to offload pressure from the hips and sacrum.

What equipment is necessary to reposition a bed-bound resident safely?

Essential equipment includes a draw sheet or slide sheet to move the resident without friction, pillows or foam wedges for positioning and support, and potentially a specialized pressure-reducing mattress or overlay, especially for higher-risk individuals.

Can repositioning schedules be different at night?

Yes, nighttime schedules may vary, especially if the resident uses a pressure-redistributing mattress. While the two-hour rule is a good general practice, some individuals can tolerate longer intervals. Always consult a healthcare provider to determine a safe nighttime schedule.

How often should you reposition a resident in a wheelchair?

Residents in wheelchairs or chairs should be repositioned at least every hour. Encourage them to shift their weight every 15 minutes if they are able. A proper pressure-redistributing cushion is also vital.

What are the first signs of a pressure ulcer?

The earliest signs include changes in skin color (redness, purple, or blue), changes in skin temperature (feeling warm or cool), or a persistent feeling of pain or itching in a specific area. Catching these signs early is key to prevention.

What is the proper way to use pillows when repositioning?

Use pillows to support the resident and keep bony prominences from touching each other. When side-lying, place a pillow between the knees and ankles, and another under the head. For back-lying, place a pillow under the calves to keep heels elevated off the mattress.