The 'Every Two Hours' Rule and Its Rationale
The most common and widely cited guideline for repositioning a bedridden individual is to turn them at least every two hours. This practice is supported by numerous health care professionals and is designed to alleviate the constant pressure on bony prominences such as the tailbone, hips, shoulders, and heels. By regularly shifting a person's position, you restore proper blood flow to these areas, which is essential for healthy skin and tissue. Prolonged pressure can restrict circulation, causing tissue breakdown and leading to the development of painful and dangerous pressure injuries, also known as bedsores.
Beyond preventing pressure injuries, consistent repositioning offers several other health benefits:
- Improved Circulation: Regular movement enhances blood flow throughout the body, benefiting overall health.
- Prevention of Contractures: Staying in a single position for too long can cause muscles and joints to stiffen and shorten. Changing positions helps maintain a range of motion and prevents these painful contractures.
- Enhanced Respiratory Function: Movement helps to prevent fluid from pooling in the lungs, reducing the risk of pneumonia and other respiratory complications.
- Increased Comfort: A change in position can provide significant relief and comfort for a bed-bound individual.
Customizing the Turning Schedule: Factors to Consider
The 'every two hours' rule is a foundation, but it is not a rigid law. A personalized care plan is always necessary, and several factors can influence whether more or less frequent turning is appropriate. For optimal care, you must become adept at assessing the individual's specific needs.
Patient-Specific Factors Influencing Frequency
- Skin Condition: Individuals with thin, fragile, or already compromised skin are at a higher risk of developing pressure injuries and may need to be turned more often. Check for redness, warmth, or blisters during every position change.
- Mobility and Activity Level: Some bedridden individuals may retain the ability to shift their weight slightly. Those with absolutely no mobility will require more diligent and consistent repositioning.
- Medical Conditions: Conditions such as diabetes, which can affect circulation, and nutritional deficiencies, which impact skin healing, can increase the risk of bedsores. Patients with these issues may need more frequent turning.
- Treatment Objectives: For hospice or end-of-life care, comfort may be the primary goal. While turning is still important, it may be adjusted to avoid unnecessary discomfort. In a hospital setting focused on recovery, more frequent turning might be required.
- Comfort Level: If the person expresses discomfort or restlessness, it's a clear sign that a position change is needed, regardless of the set schedule.
Techniques and Equipment for Safe Repositioning
To ensure the safety and comfort of both the caregiver and the bedridden person, proper technique and the right equipment are essential. Always work with another person if possible, and communicate clearly throughout the process.
- Log-Rolling: This technique involves moving the person's body as a single unit to maintain spinal alignment. It is crucial for preventing injury, especially after spinal surgery. It requires at least two caregivers.
- Using a Lift Sheet: A lift sheet, or draw sheet, is a small sheet placed beneath the person. It allows caregivers to slide and lift the person with much less friction, reducing the risk of skin tears.
- Proper Use of Pillows: Strategic use of pillows is critical for relieving pressure. Use them to prop up areas like the heels, knees, and ankles, and to maintain proper alignment on their side. Ensure no skin-to-skin contact occurs in these areas.
Comparison: Repositioning for Bed vs. Chair
| Feature | Bedridden Person | Chair-Bound Person |
|---|---|---|
| Standard Frequency | Every 2 hours | Every 15-60 minutes |
| Primary Goal | Prevent pressure injuries on back, hips, heels | Prevent pressure injuries on buttocks, tailbone, elbows |
| Key Technique | Log-rolling, using lift sheets | Weight shifts, using cushions |
| Common Pressure Points | Sacrum, coccyx, hips, heels, elbows | Ischial tuberosities (sits bones), tailbone, shoulder blades |
| Equipment | Pressure-relieving mattress, pillows, lift sheet | Pressure-relieving cushion, footrests |
Creating and Maintaining a Repositioning Plan
- Assess the Individual: Evaluate their risk for pressure injuries based on skin condition, mobility, and health factors. Consult with their physician or physical therapist to determine the ideal frequency.
- Establish a Schedule: Create a visual chart or use a caregiver app to track the times and positions for each turn. Alternate between the person's back, right side, and left side.
- Gather Equipment: Ensure you have access to a pressure-relieving mattress, pillows of various sizes, a lift sheet, and any other necessary aids.
- Perform Regular Skin Checks: Inspect all pressure points for redness, swelling, or blistering each time you reposition. Any concerning signs should prompt an immediate adjustment to the turning schedule.
- Use Proper Technique: Always protect your own back by using proper lifting and turning techniques. Two-person assists are highly recommended for safety.
- Document and Adjust: Keep a log of positions and times. If skin irritation develops, increase the turning frequency and consult a healthcare provider.
For more detailed information on preventing pressure sores, consult the National Pressure Ulcer Advisory Panel at npiap.com.
Conclusion: The Cornerstone of Bedridden Care
Consistent, careful, and customized repositioning is arguably the most important aspect of care for a bedridden individual. While the two-hour rule is an excellent starting point, a truly effective care plan requires vigilant monitoring and flexibility to meet the unique needs of the person. By understanding the risks, mastering the proper techniques, and prioritizing a personalized schedule, you can significantly improve the comfort, health, and dignity of your loved one.
