How often should you change a bed-bound person to prevent complications?

Over 2.5 million patients develop pressure ulcers annually, and most are preventable with consistent care. Knowing how often should you change a bed-bound person is crucial for maintaining skin integrity, promoting circulation, and ensuring their comfort and well-being. Proper repositioning is a fundamental part of caregiving that significantly lowers the risk of serious health complications.

Quick Summary

Repositioning a bed-bound person every two hours is the general guideline for preventing pressure sores, but this frequency can vary based on individual risk factors and the support surfaces used. Caregivers must regularly assess the person's skin, use proper turning techniques, and utilize positioning aids to ensure safety and comfort.

Key Points

• Frequency: The standard is to reposition a bed-bound person every two hours to prevent pressure ulcers.

• High-Risk Patients: Individuals at higher risk, or those on standard mattresses, may require hourly repositioning.

• Skin Checks: Check the person's skin daily for any redness, discoloration, or irritation that might indicate a developing pressure sore.

• Use a Draw Sheet: Employing a draw sheet is the safest and most effective way to turn a person, minimizing friction and caregiver strain.

• Proper Support: Use pillows and wedges strategically between knees and under ankles to relieve pressure on bony areas.

• Assistive Devices: Specialized pressure-redistribution mattresses and cushions can extend the time between repositioning.

• Teamwork: Enlist the help of another person, if available, for easier and safer repositioning, especially for individuals with limited mobility.

Why regular repositioning is vital for bed-bound individuals

For a person who is immobile or bed-bound, staying in one position for an extended period is a major risk factor for developing pressure ulcers, commonly known as bedsores. Pressure ulcers are localized injuries to the skin and underlying tissue caused by constant pressure on a single area, which restricts blood flow and leads to tissue damage. Regular repositioning is the most effective way to prevent these painful and potentially life-threatening sores.

Beyond preventing pressure ulcers, frequent repositioning offers several other key benefits for a bed-bound person:

• Improved Circulation: Changing positions stimulates blood flow, which is crucial for skin health and the function of organs and muscles.
• Enhanced Respiratory Function: Repositioning helps maintain lung function and can prevent respiratory complications like pneumonia.
• Prevention of Joint Contractures: Prolonged periods in one position can cause muscles and joints to become stiff and rigid. Regular movement helps maintain flexibility.
• Increased Comfort: Adjusting a person's position can relieve discomfort and restlessness, leading to better sleep and overall well-being.

Establishing a repositioning schedule

The universally accepted benchmark is to change a bed-bound person's position at least every two hours. For individuals at higher risk due to poor circulation, severe illness, or compromised skin integrity, more frequent changes—potentially hourly—may be necessary. The exact schedule should be determined with input from a healthcare provider who can assess the person’s specific needs.

Factors influencing repositioning frequency

Factor	Impact on Repositioning Frequency	Explanation
Skin Condition	Increase frequency	Healthy skin can tolerate pressure longer than fragile, reddened, or broken skin. If skin appears red, reposition immediately and increase frequency.
Use of a Specialized Mattress	Decrease frequency	High-quality pressure-redistribution surfaces can extend repositioning intervals from 2 hours to 4 or 6 hours, as they are designed to relieve pressure points.
Mobility Level	Increase frequency	A person who can shift their weight slightly may not need repositioning as often as someone with total immobility. Assess their ability to help.
Nutrition and Hydration	Increase frequency	Malnourished or dehydrated individuals have a higher risk of developing pressure ulcers due to poor skin health. Poor intake warrants closer monitoring.
General Health Status	Increase frequency	Conditions like diabetes, spinal cord injuries, or critical illness impact tissue tolerance and may require more frequent attention.

How to safely turn and position a bed-bound person

Repositioning should be done gently to avoid friction and shear, which can damage the skin. Using a draw sheet—a sheet folded and placed across the bed from the person's shoulders to thighs—is highly recommended. For safe repositioning, follow these steps:

1. Communicate: Always explain what you are doing to the person, even if they seem unresponsive.
2. Raise the bed: Adjust the bed to your waist level to prevent back strain. Ensure the bed rails are up on the side the person will be rolling toward.
3. Prepare the person: Gently cross the person's arms over their chest and bend their knees. If they cannot bend their knees, cross one ankle over the other.
4. Position the draw sheet: Use the draw sheet to slide the person toward the side of the bed opposite to the direction they will be turning. This provides enough room to roll them over safely.
5. Turn the person: With another person, use the draw sheet to gently roll the person onto their side. One caregiver pulls while the other pushes gently on the person's hips and shoulders.
6. Use supportive pillows: Once the person is on their side, place pillows to maintain the position and relieve pressure. Place a pillow behind their back, between their knees, and under the top arm. For those lying on their back, place a pillow under the legs from mid-calf to ankle to keep heels elevated.

Conclusion: Personalized care is key

While a two-hour turning schedule is a standard guideline for bed-bound individuals, the most effective approach is a personalized one. Caregivers must regularly assess the person's skin for any changes, consider their unique risk factors, and use appropriate equipment like supportive devices and special mattresses to provide optimal care. Developing a collaborative and realistic repositioning plan with the person and other caregivers is essential for preventing complications and promoting overall health and comfort. By remaining diligent and attentive, caregivers can significantly reduce the risk of pressure ulcers and improve the quality of life for the bed-bound individual. For more guidance, consult reputable resources such as the Agency for Healthcare Research and Quality (AHRQ), which provides extensive information on pressure ulcer prevention.

Frequently Asked Questions

What is the primary reason for changing a bed-bound person's position?

The primary reason is to prevent pressure ulcers, or bedsores, which develop when constant pressure on a bony area restricts blood flow and damages the skin.

Can I leave a bed-bound person in one position for longer than two hours at night?

While it can be challenging, the standard recommendation is to maintain the two-hour schedule at night as well. For individuals with a specialized pressure-redistribution mattress, this interval may be longer, but a healthcare provider should confirm the appropriate schedule.

What tools can help make repositioning easier?

Using a draw sheet, which is a half sheet placed under the person, makes it easier to lift and turn them without causing friction. Other aids include wedges, pillows, and specialized mattresses.

How can I tell if a pressure ulcer is forming?

Early signs include persistent redness or discoloration on the skin that doesn't fade after pressure is relieved, and the area may feel warmer or harder than the surrounding skin. In dark skin tones, look for differences in temperature or a purple, gray, or bluish patch.

Is it safe to pull a bed-bound person by their arms or legs to move them?

No, it is not safe. You should never drag or pull a person by their limbs, as this can cause friction, shear, and injury to their delicate skin. Always use a lift sheet or draw sheet to move them safely.

Does nutrition affect the risk of pressure ulcers?

Yes, poor nutrition, especially a lack of adequate protein and hydration, can make a person more susceptible to developing pressure ulcers. A balanced diet is essential for maintaining healthy skin.

What is the 30-degree tilted position?

The 30-degree tilted position is a side-lying position where the body is supported with pillows or wedges at a 30-degree angle. This helps to offload pressure from the bony areas of the hips and sacrum, where ulcers frequently occur.