How to Reposition a Bedbound Patient Safely and Effectively

According to the Agency for Healthcare Research and Quality, up to 2.5 million Americans develop pressure ulcers, or bedsores, each year. Proper and regular repositioning is a primary method for preventing these painful and potentially life-threatening wounds. This guide explains how to reposition a bedbound patient safely, detailing essential techniques and the equipment that can help reduce risk for both the patient and caregiver.

Quick Summary

This guide provides caregivers with safe techniques and tools for moving a bedridden patient, focusing on preventing pressure ulcers, improving circulation, and maintaining proper body alignment. It details step-by-step instructions for turning a patient and shifting them up in bed, emphasizes caregiver body mechanics, and outlines important supportive equipment and regular scheduling.

Key Points

• Preventing Pressure Ulcers: Regularly repositioning a bedbound patient, ideally every two hours, is the most effective way to prevent bedsores from developing.

• Use a Draw Sheet: For safety and reduced friction, always use a draw sheet to help lift and slide the patient into position, especially when moving them up in bed.

• Practice Proper Body Mechanics: To avoid injury, caregivers should bend their knees, keep their back straight, and use leg muscles instead of back muscles when moving a patient.

• Utilize Pillows for Support: Place pillows or foam wedges to support the new position, protect bony areas, and maintain proper spinal alignment. This is critical for patient comfort.

• Turn from Side to Back to Side: A rotation schedule prevents constant pressure on any single area. Include back-lying and lateral (side-lying) positions, ensuring the head of the bed is not elevated more than 30 degrees when on their back.

• Enlist Help When Needed: For heavier patients or those with limited mobility, it is safer for both the patient and caregiver to use a two-person team for repositioning.

The Importance of Repositioning Bedbound Patients

Repositioning a bedbound patient is a foundational practice in quality care, offering numerous health benefits beyond just comfort. Prolonged immobility can lead to a cascade of medical issues, which regular movement helps prevent.

• Prevents Pressure Ulcers: Constant pressure on bony prominences, such as the hips, heels, and tailbone, can restrict blood flow and lead to tissue damage and the formation of painful pressure ulcers (bedsores). Regular repositioning relieves this pressure, allowing blood to circulate freely.
• Improves Circulation: Changing a patient’s position encourages blood flow throughout the body, which is vital for skin health and prevents the formation of dangerous blood clots.
• Enhances Respiratory Function: Lying in one position for extended periods can cause fluid to pool in the lungs, increasing the risk of pneumonia. Regular turning helps keep the lungs clear and improves overall respiratory health.
• Prevents Muscle Atrophy and Joint Contractures: Without regular movement, muscles weaken and joints can become stiff, leading to contractures that limit future mobility. Repositioning helps maintain flexibility and muscle tone.

Essential Equipment for Safe Repositioning

Using the right tools is critical for both patient safety and to prevent back strain and injury for the caregiver.

• Draw Sheet: A draw sheet is a sheet or pad placed across the middle of the bed, under the patient's torso and hips. It acts as a friction-reducing device, allowing caregivers to slide the patient with less effort. Some draw sheets come with built-in handles for easier grip.
• Supportive Pillows and Wedges: Pillows, foam wedges, and specialized cushions are essential for maintaining proper body alignment and supporting new positions. These can be placed between the knees, behind the back, and under limbs to relieve pressure on vulnerable areas.
• Adjustable Bed: A hospital-style bed with adjustable height and head/foot sections can significantly reduce caregiver strain by bringing the patient to a comfortable working level.
• Bed Rails: For patients with some mobility, bed rails can provide a stable handhold for them to assist in their own repositioning.

How to Reposition a Bedbound Patient: Step-by-Step

Always remember to use proper body mechanics: bend your knees, keep your back straight, and use your leg and arm muscles, not your back. Communicate clearly with the patient throughout the process.

Moving a Patient Up in Bed

1. Prepare the environment: Lock the bed wheels and raise the bed to a comfortable working height. Lay the patient flat, if tolerated, and remove pillows.
2. Position the draw sheet: If not already in place, roll the patient to one side, tuck a rolled-up draw sheet against their back, and roll them back over the sheet. Then, roll them to the opposite side to pull the sheet through and center them.
3. Use a two-person team: For a heavy or immobile patient, enlist a second caregiver, with one person on each side of the bed. Each person should grab their side of the draw sheet at the patient's shoulders and hips.
4. Count and pull: On the count of three, both caregivers should shift their weight from their back leg to their front leg, gently pulling the patient up the bed. Avoid lifting, as this increases friction.
5. Secure the position: Re-position pillows under the head, arms, and knees as needed. For patients lying on their back, a pillow under the legs from the mid-calf to the heel can keep heels "floating" off the mattress to prevent pressure ulcers.

Turning a Patient to Their Side (Lateral Position)

1. Preparation: Lock the bed wheels and raise the bed. Explain the procedure to the patient. Stand on the side toward which you will turn the patient.
2. Move the patient toward you: Shift the patient closer to your side of the bed to provide space for the turn. For a heavy patient, use the draw sheet and a second person to move them.
3. Position the patient for the roll: Cross the patient's arms over their chest and, if possible, bend the knee farthest from you and cross that ankle over the other.
4. Roll the patient: Place one hand on the patient's far shoulder and the other on the far hip. Roll the patient gently toward you, maintaining control and using your legs. If using a draw sheet, you and your partner can pull the sheet toward you to assist with the roll.
5. Support the new position: Place a pillow or foam wedge behind the patient's back for support. Put another pillow between their knees to keep the spine aligned and alleviate pressure on the knees and ankles. Support the top arm with a pillow to prevent it from being compressed.

Comparison of Repositioning Techniques

Feature	Moving Up in Bed	Turning to Side (Lateral Position)
Primary Goal	To realign the patient and prevent sliding down, which causes shear force.	To relieve pressure on the back and buttocks, improving circulation.
Recommended Frequency	As needed throughout the day and during turns.	Every 2 hours, alternating sides.
Key Equipment	Draw sheet or slide sheet.	Draw sheet, pillows, foam wedges.
Ideal Caregiver Count	Two caregivers recommended for optimal safety and minimal strain.	One caregiver is sometimes sufficient, but two are recommended for heavier or fully immobile patients.
Key Patient Position	Flat on back with knees bent or heels floated.	Side-lying, often with a 30-degree tilt.
Main Risk to Mitigate	Shear injury from friction.	Pressure injuries on hips, ears, and ankles.

Creating a Repositioning Schedule

Consistency is key to preventing pressure injuries. Create and document a turning schedule to ensure regular repositioning. A typical schedule rotates between back, left side, and right side. For example:

• 8:00 AM: Back-lying position
• 10:00 AM: Left side (30-degree tilt)
• 12:00 PM: Back-lying position
• 2:00 PM: Right side (30-degree tilt)
• 4:00 PM: Back-lying position

For higher-risk patients or those with existing skin issues, more frequent repositioning, such as every hour, may be necessary. Always check the patient's skin for redness during each position change.

Conclusion

Knowing how to reposition a bedbound patient correctly is an essential skill for any caregiver. By using proper techniques, enlisting help when needed, and utilizing supportive equipment like draw sheets and pillows, caregivers can significantly reduce the risk of pressure ulcers and other complications associated with prolonged immobility. Regular, scheduled repositioning improves blood circulation, respiratory function, and overall patient comfort. Implementing these practices not only protects the patient's health and dignity but also ensures the caregiver's own safety by promoting proper body mechanics. Adhering to these guidelines is a compassionate and effective way to provide high-quality care for bedbound individuals. For more information on supportive equipment and patient handling techniques, you can consult with healthcare suppliers.

Frequently Asked Questions

How often should you reposition a bedbound patient?

For most bedbound patients, the recommended frequency is every two hours. However, some higher-risk patients may need more frequent repositioning, possibly every hour, especially if they have fragile skin or existing pressure ulcers.

What is the 'Rule of 30' for repositioning?

The 'Rule of 30' is a guideline for preventing pressure injuries by repositioning a patient into a 30-degree laterally inclined position. This involves tilting the patient's shoulders and hips 30 degrees from a flat back-lying position, using pillows to maintain the angle and offload pressure.

What is a draw sheet and how is it used?

A draw sheet is a special sheet or pad placed under a patient's torso to help caregivers slide and reposition them with less friction and effort. To use it, a two-person team lifts the patient by gripping the sheet on either side and moves them in the desired direction.

Why is it important for caregivers to use proper body mechanics?

Using proper body mechanics, such as bending at the knees instead of the waist and keeping the patient close to your body, prevents the caregiver from sustaining back injuries. Repetitive strain from improper lifting is a common cause of injury among caregivers.

What are some common positions for bedbound patients?

Common positions include the supine (back-lying) position, lateral (side-lying) position, and the 30-degree tilted position. Supportive devices like pillows and wedges are used in all positions to maintain comfort and alignment.

How can pillows be used to support a patient?

Pillows can be placed strategically to support the patient's head and neck, behind their back to maintain a side-lying position, and between their knees to align the spine. For patients on their backs, pillows can elevate legs to float the heels, preventing pressure on them.

How do you reposition a patient with limited mobility?

For patients with limited mobility, it's best to use a two-person team and a draw sheet. The caregivers work together to lift and slide the patient, following the steps for moving up or turning, to ensure the patient's safety and comfort.