How often should you turn a bedridden patient?

According to the Agency for Healthcare Research and Quality, millions of patients in the US suffer from pressure ulcers each year, but most are preventable. A fundamental part of prevention is knowing how often should you turn a bedridden patient to protect their skin, maintain circulation, and ensure their comfort.

Quick Summary

Repositioning a bedridden patient is vital for preventing pressure ulcers, typically requiring a turn every two hours, with individualized adjustments based on the patient's specific risk factors and comfort level.

Key Points

• Standard Guideline: The general recommendation is to turn a bedridden patient at least every two hours to prevent pressure ulcers, also known as bedsores.

• Individualized Care: The optimal turning schedule should be customized based on the patient's specific risk factors, medical condition, skin tolerance, and overall comfort.

• Safe Techniques: Use proper body mechanics, and leverage tools like draw sheets, slide sheets, and wedge cushions to turn patients safely and minimize friction and shear on the skin.

• Regular Skin Checks: Conduct a thorough skin assessment over bony areas every time you reposition the patient to check for redness, swelling, or open sores.

• Comprehensive Strategy: Turning is part of a larger care plan that should also include proper nutrition, hydration, and meticulous incontinence and skin care.

• Positional Aids: Use pillows, cushions, and wedges to support the patient in various positions, such as the 30-degree tilted side-lying position, to maximize pressure relief.

• Caregiver Safety: Prioritize your own safety by using the right techniques and equipment, seeking assistance for heavier patients, and taking breaks.

The Importance of Repositioning a Bedridden Patient

Regular repositioning is a cornerstone of care for anyone with limited mobility, particularly bedridden patients. Remaining in one position for extended periods can lead to serious health complications beyond just discomfort. Immobility can lead to compromised circulation, increasing the risk of dangerous blood clots and fluid build-up in the lungs, which can cause respiratory issues like pneumonia. Muscles can also atrophy quickly without regular movement, and joints can become stiff and contractured.

The Risk of Pressure Ulcers

The most well-known and painful complication of immobility is the development of pressure ulcers, also known as bedsores. These wounds form when constant pressure on a specific area of the body reduces blood flow to the tissues. Without sufficient oxygen and nutrients, the skin and underlying tissue can become damaged and die. Common areas for pressure ulcers include the hips, tailbone (sacrum), heels, shoulder blades, and elbows—anywhere a bone is close to the skin's surface.

Establishing a Turning Schedule

The most widely accepted guideline for bedridden patients is to reposition them at least every two hours. For individuals sitting in a wheelchair, repositioning should be even more frequent, approximately every 15 to 60 minutes, depending on their ability to shift their weight. However, this is a general guideline, and a patient's schedule should always be individualized based on several key factors:

• Tissue tolerance: The time it takes for a patient's skin to show redness over a bony prominence is an important indicator. Once this is determined, the turning frequency should be set to 30 minutes less than that time.
• Risk assessment scores: Tools like the Braden Scale or Norton Scale can help assess a patient's specific risk level for developing pressure ulcers by evaluating factors like sensory perception, activity, mobility, moisture, nutrition, and friction/shear.
• Medical condition and comfort: A patient's overall health, treatment objectives, and comfort level should influence their turning schedule. Some patients may be more fragile and require more frequent turning.

The 30-Degree Tilted Side-Lying Position

When turning a patient onto their side, a 30-degree tilted position is often recommended. This technique effectively relieves pressure from the hip bone (greater trochanter) and sacrum by distributing weight more evenly across a larger surface area. This position can be achieved by placing pillows or foam wedges under the patient to maintain the angle.

Turning at Night

For bedridden patients, especially those with mattresses designed for pressure redistribution, extending the interval between turns at night to three or four hours may be possible, but this should be assessed and approved by a healthcare professional. Continuous monitoring of the patient's skin is essential, regardless of the schedule.

Techniques and Equipment for Safe Turning

Proper technique and equipment are crucial for both the patient's safety and the caregiver's wellbeing, as incorrect methods can cause injury to both parties.

Proper Body Mechanics

To avoid straining your back, remember to bend your knees, not your back, and use your body weight to assist the movement. Keep the patient close to your body and move with slow, controlled motions. If the patient is heavy or unable to assist, a two-person turn may be necessary.

Helpful Equipment

• Draw Sheets: These small, folded sheets are placed under the patient's torso and thighs to help lift and slide them, reducing friction and shear on the skin.
• Wedge Cushions: Foam or air-filled wedges can be used to prop a patient on their side at the ideal 30-degree angle.
• Slide Sheets: Specialized sheets made of slippery material allow for easy repositioning with minimal effort and friction.
• Turning Devices: Patient turning devices and support pillows with special straps are available to help with positioning and reduce caregiver strain.

The Role of Skin Assessment

Every time you reposition a patient, it is crucial to perform a visual skin assessment, especially over bony areas. Look for signs of trouble, such as:

• Skin discoloration: Redness, purple, or blue patches that do not blanch (turn white) when gently pressed.
• Swelling or warmth: An area that is swollen or feels warmer or cooler than the surrounding skin.
• Blisters or open sores: The presence of abrasions, blisters, or more advanced ulcers.
• Pain or discomfort: The patient's verbal or non-verbal signs of pain.

A Sample Repositioning Plan

Caregivers can use a simple chart to create a customized turning schedule. This helps ensure consistency and proper rotation, documenting the time and position changes. Below is an example, but it must be adapted to the patient's specific needs.

Time	Position	Skin Assessment	Notes
8:00 AM	Supine (on back)	Redness check on sacrum, heels.	Use heel protectors.
10:00 AM	Right Side (30° tilt)	Check hip, shoulder.	Use pillows between knees.
12:00 PM	Supine (on back)	Check back, heels.	Head of bed no higher than 30°.
2:00 PM	Left Side (30° tilt)	Check hip, shoulder.	Use pillows to support limbs.
4:00 PM	Supine (on back)	Check back, heels.	Use rolled towel for lumbar support.
6:00 PM	Right Side (30° tilt)	Check hip, shoulder.	Ensure proper spinal alignment.
8:00 PM	Supine (on back)	Check back, heels.	Document any changes.
10:00 PM	Left Side (30° tilt)	Check hip, shoulder.	Ensure patient is comfortable for sleep.

Beyond Turning: Comprehensive Pressure Ulcer Prevention

While turning is essential, it is only one component of comprehensive care. Other vital aspects include:

• Maintaining good nutrition and hydration: Proper intake of fluids, protein, vitamins, and minerals supports healthy skin.
• Managing incontinence: Keeping the skin clean and dry, especially from urine and stool, is critical as moisture can increase vulnerability to skin breakdown.
• Using proper bedding and support surfaces: Special mattresses or overlays, cushions, and pillows can help redistribute pressure away from bony prominences. Ring-shaped cushions should be avoided as they can cause pressure points.
• Minimizing friction and shear: Ensure the patient is lifted, not dragged, during repositioning. Using a draw sheet is key to this.

Conclusion

For those caring for bedridden patients, the question of how often should you turn a bedridden patient is paramount to preventing pressure ulcers and other complications. While the general rule is every two hours, the most effective strategy is a personalized, diligent approach based on a patient's individual risk factors, comfort, and skin tolerance. By incorporating safe turning techniques, using appropriate equipment, and conducting regular skin assessments, caregivers can significantly improve the health, comfort, and quality of life for their loved ones.

For additional support on caregiving techniques and other valuable resources, consider visiting the Caregiver Action Network.

Frequently Asked Questions

What is a pressure ulcer and why does a bedridden patient need to be turned?

A pressure ulcer, or bedsore, is an injury to the skin and underlying tissue resulting from prolonged pressure on one area of the body. A bedridden patient needs to be turned to relieve this constant pressure, maintain blood flow to the skin, and prevent tissue damage.

How often should a patient in a wheelchair be repositioned?

Patients in wheelchairs should be repositioned more frequently than bed-bound patients. Caregivers should move them at least every hour, and encourage patients who can to shift their weight every 15 minutes.

What is the 30-degree side-lying position and why is it recommended?

The 30-degree side-lying position is a repositioning technique that involves tilting the patient at a slight angle to their side, supported by pillows or wedges. It is recommended because it helps relieve pressure from the hip bone and sacrum more effectively than a full side-lying position.

What equipment is most helpful for turning a patient?

Helpful equipment includes draw sheets or slide sheets to reduce friction, pillows or foam wedges to support new positions, and specialized turning devices for heavier patients or those with specific needs.

What are the first signs of a bedsore to look for during a skin check?

The first signs of a bedsore include skin discoloration (red, purple, or blue) that doesn't go away after pressure is relieved, swelling, or an area that feels warmer or cooler than the surrounding skin.

Can a bedridden patient be turned less often at night?

For some patients, especially those using pressure-redistributing mattresses, it may be possible to extend the turning interval at night to three or four hours. However, this decision should always be based on a clinical assessment and continuous monitoring.

What is the difference between friction and shear?

Friction occurs when the skin rubs against a surface, like bedding. Shear occurs when two surfaces move in opposite directions, such as when a patient slides down in bed while their skin stays in place, stretching and damaging underlying tissue.

How can caregivers protect themselves from injury while turning a patient?

Caregivers should use proper body mechanics, bending their knees and lifting with their legs. They should also use equipment like draw sheets and ask for help with heavier patients to prevent straining their backs.