The Importance of Frequent Repositioning
For individuals confined to a bed for extended periods, immobility is a major risk factor for several serious health issues, most notably pressure ulcers, also known as bedsores. Pressure ulcers develop when constant pressure on a specific area of the body reduces blood flow, leading to tissue damage and skin breakdown. Regular repositioning, or turning, is the most effective preventative measure against these painful and dangerous wounds.
Beyond preventing pressure ulcers, frequent repositioning provides a number of other vital health benefits:
- Improved Circulation: Changing positions stimulates blood flow throughout the body, which is essential for maintaining healthy skin and tissue integrity.
- Prevention of Contractures: Staying in one position for too long can cause muscles and joints to stiffen and shorten, leading to contractures that limit mobility.
- Enhanced Respiratory Function: Repositioning helps prevent fluid from accumulating in the lungs, reducing the risk of pneumonia and other respiratory complications.
- Better Comfort and Quality of Life: Regular changes in position alleviate discomfort, reduce pain, and improve overall well-being for the patient.
The Standard Repositioning Schedule
For most bedfast individuals, the standard recommendation is to reposition them at least every two hours. This consistent schedule helps ensure that no single area of the body is subjected to prolonged, uninterrupted pressure. A systematic approach is crucial, alternating positions to distribute pressure evenly across different body parts. A typical rotation might involve moving the person from a supine (on the back) position to a lateral (side-lying) position, and then alternating between the left and right sides.
Creating a Turning Schedule
Caregivers can use a turning schedule chart to track repositioning times and positions, which is especially helpful in busy care environments. Some key considerations for a turning schedule include:
- Documentation: Keeping a log of when and to which position the person was moved helps ensure consistency and prevents any one position from being held for too long.
- Systematic Rotation: Plan out a logical sequence of positions to follow.
- Nighttime Adjustments: While the two-hour rule is standard, some individualized care plans might allow for longer intervals at night to permit uninterrupted sleep, especially with specialized mattresses.
Factors Influencing Repositioning Frequency
While the two-hour rule is a general guideline, the ideal frequency for repositioning can vary significantly based on an individual's specific circumstances. High-risk patients may need more frequent repositioning, sometimes as often as every hour, particularly if they have existing pressure ulcers or multiple risk factors.
Here are some of the key factors that influence repositioning frequency:
- Skin Condition: The presence of redness, irritation, or existing pressure ulcers may necessitate more frequent repositioning to relieve pressure on compromised areas.
- Braden Scale Score: Healthcare professionals often use a standardized tool like the Braden Scale to assess a patient's risk of developing pressure injuries.
- Medical Condition: Conditions that compromise circulation, such as diabetes or vascular disease, can increase the risk of pressure ulcers.
- Nutritional Status: Poor nutrition can weaken the skin and tissues, making them more susceptible to breakdown.
- Support Surfaces: The type of mattress or cushion used can affect the repositioning schedule. Pressure-redistributing mattresses, for example, may allow for less frequent turns than a standard bed.
Safe and Effective Repositioning Techniques
Proper technique is just as important as frequency when it comes to repositioning. Poor technique can cause shearing and friction, which can damage the skin just as much as prolonged pressure.
To reposition a bedfast person safely:
- Work with a Partner (if possible): For individuals with limited mobility, having two people can make the process safer and easier, reducing strain on the caregiver and the patient.
- Use a Draw Sheet: A draw sheet placed under the person from their shoulders to thighs can be used to lift and move them, minimizing friction.
- Use Proper Body Mechanics: Bend at your knees, not your back, and use your legs to do the lifting.
- Communicate with the Person: Explain what you are doing, even if they appear unconscious, to maintain their dignity and provide reassurance.
- Utilize Support Pillows: Pillows and wedges are essential for maintaining proper body alignment and offloading pressure.
Comparison of Repositioning Positions
| Position | Description | Key Benefits | Potential Drawbacks |
|---|---|---|---|
| Supine (Lying on Back) | Patient is lying flat on their back, often with head slightly elevated (no more than 30 degrees). | Relieves pressure from hips and sides. Supports respiratory function. | Increases pressure on sacrum, heels, and back of head. Can cause fluid build-up in lungs if bed angle is too high. |
| Lateral (Side-Lying) | Patient is turned onto their side, with pillows supporting the back, head, and between the knees. | Relieves pressure on the sacrum, heels, and spine. Improves circulation on these areas. | Can put pressure on the hip and shoulder of the side they are lying on if not correctly supported. |
| 30-Degree Tilt | A specific variation of the side-lying position where the patient is positioned at a 30-degree angle from their back. | Considered an optimal position for pressure redistribution, particularly over the sacrum and coccyx, as it avoids direct pressure on the hip bone. | Requires precise pillow or wedge placement to maintain the correct angle. |
Using Assistive Devices
Beyond regular repositioning, several assistive devices can enhance care and prevent pressure injuries:
- Pressure-Redistributing Mattresses: These specialized mattresses, including alternating pressure and low-air-loss types, distribute weight more evenly across the body.
- Positioning Wedges: Foam wedges are used to maintain side-lying positions and prevent the person from rolling onto their back.
- Heel Protectors/Floatation Boots: Devices that suspend the heels off the mattress completely eliminate pressure on this high-risk area.
- Slide Sheets: Friction-reducing sheets make it easier to move a person without causing shear injuries.
For more in-depth information on patient safety and care, the National Pressure Injury Advisory Panel (NPIAP) provides a wealth of resources and guidelines on preventing pressure injuries. Their website is an invaluable resource for caregivers seeking authoritative, evidence-based information.
Conclusion: A Proactive Approach to Care
Knowing how often should a bedfast person be repositioned is a fundamental aspect of providing high-quality care and is not a one-size-fits-all solution. While a two-hour schedule is the widely accepted standard, tailoring a routine based on the individual's specific risk factors and using proper techniques are critical for preventing serious complications like pressure ulcers. Consistent repositioning, combined with meticulous skin care and the use of assistive devices, ensures the bedfast person remains as comfortable and healthy as possible, greatly improving their overall well-being.
