How often should a bedridden client be turned to prevent pressure injuries?

According to the National Institutes of Health, pressure ulcers affect approximately 2.5 million patients each year in U.S. acute care facilities. A critical component of preventing these painful and dangerous wounds is knowing how often should a bedridden client be turned to effectively alleviate pressure and promote healthy circulation.

Quick Summary

Repositioning a bedridden individual every two hours is the standard guideline to prevent the development of bedsores. However, a customized turning schedule based on individual risk factors, like skin condition and mobility, is often necessary for optimal care and well-being.

Key Points

• Standard Practice: The accepted standard guideline is to reposition a bedridden client every two hours to prevent pressure ulcers, but individualized needs may require more frequent turning.

• Risk Assessment: Factors like skin tolerance, mobility level, and underlying medical conditions determine a person's specific risk for developing bedsores and should inform their turning schedule.

• Proper Technique: Use a draw sheet and proper body mechanics to safely turn a patient, which reduces the risk of skin friction (shearing) and caregiver injury.

• Use Support Tools: Use pillows, cushions, or foam wedges to support the patient in their new position, especially between knees and ankles, to offload pressure from bony prominences.

• Alternate Positions: Varying the patient's position (supine, lateral, 30-degree incline) and not keeping them in a single spot for too long helps distribute pressure evenly across the body.

• Holistic Benefits: Beyond preventing bedsores, regular repositioning improves circulation, enhances respiratory function, and increases overall comfort for the patient.

• Document Everything: Maintain a clear and documented turning schedule to ensure consistent care and track positions, which helps prevent missed turns and monitors effectiveness.

Understanding the 'Every Two Hours' Guideline

The recommendation to turn a bedridden client every two hours is a long-established standard in healthcare settings, supported by federal safety standards for nursing homes. This guideline serves as a general rule of thumb to ensure consistent pressure relief for individuals with limited or no mobility. The primary reason for this frequency is to prevent pressure ulcers, which can develop when prolonged pressure on bony areas restricts blood flow to the skin and underlying tissues.

For many patients, especially those who are frail, elderly, or have specific medical conditions, following this schedule diligently is non-negotiable. Skipping a turn can significantly increase the risk of skin breakdown, leading to infections, and in severe cases, life-threatening complications. Consistent two-hour repositioning is a foundational preventative measure that all caregivers should understand and implement.

Factors That Influence a Customized Turning Schedule

While the two-hour rule is a reliable starting point, an individualized approach is essential for truly effective care. Several factors can affect a patient's risk level and, therefore, their ideal turning frequency.

Individual Risk Factors:

• Tissue Tolerance: A person with fragile skin or pre-existing conditions like diabetes may be more susceptible to skin breakdown. A caregiver should assess how quickly redness occurs over bony prominences and adjust the schedule accordingly.
• Mobility Level: A patient with some ability to shift their weight may require less frequent repositioning than someone who is completely immobile. However, even small movements can make a difference and should be encouraged.
• Medical Condition: Certain health issues, including vascular disease, incontinence, and malnutrition, can increase the risk of pressure ulcers. A detailed turning plan should account for these co-morbidities.
• Comfort Level: A patient's feedback on their comfort and any signs of discomfort can be a crucial indicator for adjusting the schedule. Paying close attention to both verbal and non-verbal cues is vital.

The Caregiver's Role: Safe Repositioning Techniques

Proper technique is just as important as frequency to ensure the safety and comfort of the bedridden client. Improper turning can cause friction and shearing, which can also damage skin.

1. Preparation: Before beginning, explain the process to the patient, even if they are non-verbal. Raise the bed to a comfortable working height for the caregiver and lock the wheels.
2. Use a Draw Sheet: Placing a draw sheet (a sheet folded in half under the patient's torso) can make turning easier and reduce skin friction. It is often a two-person job for safety and to prevent caregiver injury.
3. Proper Body Mechanics: Use the draw sheet to gently roll the patient. Keep your back straight, bend your knees, and use your body weight rather than your arms to move the patient.
4. Support New Position: Use pillows, foam wedges, or specialized cushions to support the patient in their new position. A pillow between the knees and ankles can prevent pressure on joints.

Comparison of Repositioning Positions

Different positioning techniques offer various benefits for relieving pressure on specific body areas. The National Institutes of Health provides detailed guidelines for different positions.

Position	Description	Benefits	Cautions
Supine (Lying on back)	Patient lies flat on their back with small pillows under the head, shoulders, and knees.	Comfortable for many; good for spinal alignment.	High-pressure risk on the tailbone, elbows, and heels; head of bed should be no more than 30 degrees to avoid shearing.
Lateral (Side-lying)	Patient lies on their side with a pillow behind the back and between the knees.	Relieves pressure from the back and tailbone.	Ensure proper spinal alignment; requires careful support to prevent rolling back onto the spine.
30-Degree Lateral Incline	Patient is tilted at a 30-degree angle, supported by pillows or wedges.	A safer, more stable alternative to a full side-lying position; significantly reduces pressure on the sacrum.	Requires proper positioning with support devices to maintain the angle effectively.
Prone (Lying on stomach)	Patient lies on their stomach with the head turned to the side and pillows under the torso and feet.	Excellent for drainage and full relief of posterior pressure points.	Less commonly used for elderly patients; can be difficult to position and monitor.

The Broader Impact of Regular Repositioning

Beyond preventing pressure ulcers, regular repositioning offers several other health benefits that contribute to a bedridden person's overall well-being:

• Improved Circulation: Regular movement helps stimulate blood flow throughout the body, reducing the risk of dangerous blood clots like deep vein thrombosis.
• Enhanced Respiratory Health: Changing positions helps prevent fluid buildup in the lungs, which can lead to complications such as pneumonia. It allows for better lung expansion and secretion drainage.
• Increased Comfort: Regular repositioning helps alleviate stiffness and discomfort from staying in one position for too long. It can improve a patient's mood and overall quality of life.
• Maintain Skin Integrity: It's an opportunity for the caregiver to perform regular skin checks, identifying early signs of irritation or redness before a more serious wound develops.

For additional guidance, the Caregiver Action Network provides excellent resources for safely repositioning bedridden individuals.

Implementing a Repositioning Plan

To ensure consistent and effective care, a clear plan should be established. This plan should include a documented schedule outlining the time of each turn and the position used. A turning chart is an effective tool to track this information and ensure no turns are missed. When creating the schedule, it's beneficial to alternate between different positions to distribute pressure across the body evenly.

In conclusion, while the standard two-hour rule for turning bedridden clients is a crucial guideline, it is a starting point for a more comprehensive care plan. By understanding the individual's specific risk factors, using proper techniques, and incorporating different positions, caregivers can significantly reduce the risk of pressure injuries and promote a higher quality of life for the person in their care. Consistent, well-planned repositioning is one of the most vital tasks for any caregiver supporting a bedridden individual.

Frequently Asked Questions

Why is a two-hour turning schedule recommended for bedridden clients?

A two-hour schedule is the standard practice because it prevents sustained pressure on bony areas, which is the primary cause of pressure ulcers (bedsores). This frequency helps ensure healthy blood flow to the skin and tissues, protecting them from damage.

Can a bedridden client be turned less often, for example, during the night?

In some cases, a patient's individual risk assessment and use of specialized pressure-relieving mattresses may allow for less frequent turning during the night, perhaps every four hours. However, this should only be done under a healthcare provider's guidance and with careful monitoring.

What is the 'Rule of 30' when repositioning a patient?

The 'Rule of 30' involves elevating the head of the bed no more than 30 degrees and placing the patient in a 30-degree laterally inclined position. This technique is recommended by wound care specialists because it significantly reduces pressure on the sacrum and buttocks.

What tools can help make turning a bedridden client easier and safer?

Caregivers can use a variety of tools, including draw sheets, wedge cushions, specialized pillows, and turning sheets. These aids help to reduce friction on the patient's skin and minimize strain on the caregiver.

How can I tell if a turning schedule needs to be adjusted?

You should check the patient's skin daily, especially over bony areas like the tailbone, hips, and ankles, for any signs of redness, warmth, or irritation. If these signs appear, it may indicate that the current turning frequency or technique is not sufficient and needs adjustment.

Is it better to turn a bedridden person with a friend or alone?

For safety and effective repositioning, especially for individuals with limited mobility, it is often best to turn with the help of a second person. This reduces the risk of injury to both the patient and the caregiver, and ensures the patient is moved properly.

What are the risks of not turning a bedridden client often enough?

Insufficient turning can lead to a number of serious health issues, including pressure ulcers (bedsores), compromised circulation, respiratory problems like pneumonia, and muscle atrophy. Regular repositioning is critical for preventing these complications.