Understanding How Often Should Bedbound Be Repositioned to Prevent Complications

According to the National Institutes of Health, millions of patients in the U.S. suffer from pressure injuries each year, with most being preventable. For bedbound individuals, consistent repositioning is the single most critical intervention to mitigate this and other health risks associated with immobility.

Quick Summary

Repositioning bedbound individuals every two hours is the general guideline for preventing pressure injuries, though high-risk patients may require repositioning every hour. The specific schedule should be customized based on individual factors like skin condition, mobility, and overall health.

Key Points

• Two-Hour Rule: The general recommendation is to reposition bedbound individuals at least every two hours to prevent pressure ulcers, but this can be adjusted based on individual risk.

• High-Risk Requires More Frequent Turns: Patients with fragile skin, poor circulation, or existing pressure sores may need repositioning as often as every hour.

• Lift, Don't Drag: Always use proper body mechanics and assistive devices like draw sheets to lift and move the patient, which prevents shearing and friction on the skin.

• Use Pillows and Wedges: Place supportive cushions behind the back, between the knees, and under the calves to maintain proper body alignment and offload pressure from bony areas.

• Integrate with Daily Care: Combine repositioning with daily skin checks for redness, moisture control, and ensuring adequate nutrition and hydration for optimal skin health.

The Core Principle: Why Frequent Repositioning is Essential

Staying in one position for extended periods, even as short as one to two hours, creates constant pressure on certain parts of the body, particularly over bony prominences like the tailbone, hips, heels, and elbows. This prolonged pressure restricts blood flow to the skin and underlying tissues. Without proper circulation, the tissue becomes starved of oxygen and nutrients, leading to cell death and the formation of painful pressure ulcers, also known as bedsores.

Beyond Pressure Ulcer Prevention

While preventing bedsores is the primary goal, regular repositioning offers a host of other crucial benefits for bedbound individuals, including improved circulation, enhanced respiratory function, and preventing joint stiffness and contractures. It can also promote emotional well-being by reducing feelings of isolation.

Establishing a Repositioning Schedule

Creating and adhering to a systematic repositioning schedule is fundamental to effective care. For most bedbound individuals, the standard recommendation is to reposition them at least every two hours. This frequency may need to be adjusted based on individual risk factors, as some patients require more frequent repositioning. Factors that increase risk include advanced age, incontinence, lack of sensory perception, poor nutrition, and underlying health issues.

Customizing the Turning Schedule

An effective repositioning plan should be personalized. Daily skin assessments, particularly over bony areas, should be performed and documented during each turn. If redness or discoloration is present, adjust the schedule or positioning technique. The time it takes for redness to fade can indicate tissue tolerance and help determine a safe interval. For wheelchair-bound individuals, repositioning is needed more frequently, typically every 15 minutes if they can shift weight, or every hour if they need assistance.

Techniques for Safe and Proper Repositioning

Caregivers must use proper techniques to ensure patient safety and avoid injury to themselves. Never drag a bedbound person, as this can cause friction and shearing injuries to the skin.

Turning a Patient to Their Side (30-Degree Tilt)

1. Raise the bed to a comfortable working height and lock the wheels.
2. Communicate with the person, explaining each step.
3. Have the person bend their knees and fold their arms across their chest.
4. Stand on the side you are turning them towards. Cross their top ankle over the bottom one.
5. Using a draw sheet, gently pull and roll them toward you.
6. Place pillows or wedge cushions behind their back and between their knees to maintain the 30-degree tilt.

Using a Draw Sheet to Move a Person Up in Bed

For repositioning a person who has slid down, a draw sheet is critical. This is a two-person task for safety.

1. Roll the person to one side, tucking the draw sheet halfway under them. Roll them back onto the sheet.
2. With a person on each side, grasp the sheet near the shoulders and hips.
3. On a count of three, lift together, moving the person up the bed smoothly to avoid dragging.

Proper Body Alignment and Support

Regardless of the position, use pillows and cushions to support proper body alignment and relieve pressure on vulnerable areas. Key placements include between knees and ankles, behind the back, under the calves to 'float' heels, and under forearms.

Assistive Devices and Supportive Surfaces

For optimal care, especially for individuals at high risk, combining manual repositioning with assistive technology is recommended.

Device	Purpose	Benefits
Draw Sheets	Used to lift and move the patient without dragging.	Reduces friction and shear injuries, protects skin, and reduces caregiver strain.
Pressure-Relieving Mattresses	Designed to redistribute pressure more evenly across the body.	Improves blood circulation and reduces the risk of pressure ulcers.
Wedge Cushions	Used to support the back and limbs in a tilted or lateral position.	Promotes stability and offloads pressure from bony areas.
Trapeze Bar	An overhead bar that the patient can grab to assist with repositioning.	Allows a person with some upper body strength to participate in their own care and shift weight independently.
Heel and Elbow Protectors	Soft pads or cushions that shield bony areas from pressure.	Provides localized protection for high-risk areas.

The Role of Skin Integrity and Overall Health

Repositioning is just one part of a comprehensive care plan. Other vital components include daily skin inspections, maintaining cleanliness, ensuring adequate nutrition and hydration, and gentle exercise if possible. The National Pressure Ulcer Advisory Panel is an excellent resource for evidence-based guidelines and patient information.

Conclusion

Understanding how often should bedbound be repositioned is a crucial part of providing compassionate and effective care. While the standard two-hour rule is a reliable starting point, the best approach is always an individualized one, based on a person’s specific risk factors and overall health. Combining a consistent repositioning schedule with proper techniques, supportive equipment, and diligent skin care is the most effective strategy for preventing painful complications and ensuring the comfort and dignity of bedbound individuals.

Frequently Asked Questions

How often should a bedbound person in a wheelchair be repositioned?

Individuals who spend significant time in a wheelchair need more frequent repositioning than those in bed. The recommended frequency is every hour for those requiring full assistance, and every 15 minutes for those who can shift their weight independently.

What is the 30-degree lateral position for repositioning?

The 30-degree lateral position involves tilting the person's body to the side at a 30-degree angle, supported by pillows or wedge cushions. This position helps to redistribute pressure away from the sacrum and hips, reducing the risk of bedsores.

Are there automated devices that reposition bedbound patients?

Yes, some specialized pressure-redistributing mattresses have automated turning functions. While helpful, manual repositioning and regular skin checks remain crucial to supplement automated systems.

What are the first signs of a pressure ulcer I should look for?

Early signs include redness or discoloration that doesn't fade when pressed, warmth, swelling, or a burning sensation over bony areas. Daily skin inspections are essential for catching these warning signs.

What are draw sheets and how are they used?

Draw sheets are slippery, nylon or microfiber sheets placed under a bedbound person. They allow caregivers to lift and slide the person up or across the bed, minimizing friction and making repositioning easier and safer for both the caregiver and the patient.

Can I use a donut-shaped cushion for my bedbound loved one?

No, donut-shaped cushions are not recommended. They can restrict blood flow and cause tissue swelling, actually increasing the risk of pressure ulcers instead of preventing them.

Does having a special mattress mean I don't need to reposition?

Even with a pressure-relieving mattress, regular repositioning is still necessary. No single device can completely replace the need for changing positions to promote circulation and prevent tissue breakdown.