How to Use a Repositioning Sheet for Safe and Effective Caregiving

Improper patient handling accounts for a high percentage of caregiver injuries, making safe techniques essential for both parties. Learning how to use a repositioning sheet is a critical skill for caregivers that helps prevent musculoskeletal strain and protects the patient's skin and dignity.

Quick Summary

A repositioning sheet uses low-friction material to help caregivers safely slide a patient into a new position, reducing strain for the caregiver and preventing skin shear for the patient. It requires coordination, proper body mechanics, and clear communication, whether working with one or two people.

Key Points

• Reduce Friction: Repositioning sheets are low-friction, meaning they are for sliding patients, not lifting them, to prevent injury.

• Always Communicate: Talk to the patient throughout the process to ensure their comfort and cooperation.

• Practice Proper Body Mechanics: Bend with your knees and use your body weight to slide the patient, keeping your back straight.

• Ensure Bed Safety: Always lock the bed wheels and adjust the bed to a comfortable working height before beginning any maneuver.

• Team Up for Safety: For heavier or less mobile patients, a two-person assist is necessary to protect both caregivers and the patient.

• Check Skin Regularly: Use repositioning moments as an opportunity to inspect the patient's skin for signs of redness or pressure.

Understanding Repositioning Sheets

Repositioning sheets, often called slide sheets or transfer sheets, are made of a slick, low-friction material designed to reduce the force required to move a patient. They are an essential tool in safe patient handling, a method endorsed by healthcare professionals to prevent caregiver injuries and improve patient comfort. Repositioning sheets come in various forms, including tubular designs and flat sheets with or without handles, each suited for different tasks.

Benefits of Using a Repositioning Sheet

• Prevents Skin Damage: Dragging a patient across a standard sheet can cause painful skin friction and shear, leading to pressure ulcers. Repositioning sheets allow the patient to glide smoothly, protecting skin integrity.
• Reduces Caregiver Strain: The ergonomic design of these sheets significantly reduces the physical effort needed to move a patient, helping to prevent back injuries and other musculoskeletal problems for caregivers.
• Increases Patient Comfort: With less tugging and pulling, the patient experiences a smoother, more dignified transfer, which can reduce anxiety and discomfort.
• Enhances Efficiency: Using the right technique, repositioning sheets allow for quicker, more efficient patient transfers and adjustments, making daily care tasks less time-consuming.

Step-by-Step Guide: How to Use a Repositioning Sheet

Proper preparation and technique are crucial. Always communicate with the patient throughout the process to ensure their cooperation and comfort.

Step 1: Preparation

1. Lower the bed: Adjust the bed to a comfortable and safe working height for the caregiver(s) to minimize back strain. Ensure the bed is flat and the wheels are locked.
2. Explain the process: Verbally explain each step to the patient to reduce fear and encourage their participation, if possible.
3. Position the patient: Roll the patient onto their side, turning away from you. Bend the patient's top knee to provide stability.

Step 2: Placing the Sheet

1. Fold the sheet: Roll or fan-fold the repositioning sheet lengthwise. If using a tubular sheet, it will already be in a closed-loop format.
2. Tuck the sheet: Tuck the folded sheet under the patient's side, positioning it so that it will span from the patient's head to their thighs or feet. The center of the sheet should align with the patient's torso.
3. Roll back and unfold: Gently roll the patient back onto their back, over the folded portion of the sheet. Now move to the other side of the bed, roll the patient toward you again, and pull the folded sheet through until it lies flat beneath them.

Step 3: Repositioning the Patient Up in Bed (Two-Person Assist)

This technique is ideal for moving a patient up toward the head of the bed.

1. Position caregivers: Both caregivers should stand on opposite sides of the bed, one near the patient's shoulders and the other near the hips.
2. Patient preparation: Instruct the patient to cross their arms over their chest and tuck their chin to protect their head and neck.
3. Grasp and slide: Each caregiver should firmly grasp the repositioning sheet at the patient's shoulder and hip level. With good body mechanics (bent knees, straight back) and on a coordinated count, slide the patient smoothly up the bed. Avoid lifting.
4. Remove the sheet: Once the patient is in place, roll them to one side and gently pull the sheet out from underneath. Never leave a slide sheet under a patient for an extended period, as it can be a fall risk and contribute to skin breakdown.

Step 4: Turning the Patient onto Their Side (Single-Person Assist)

For a side-lying position, especially for skin care or pressure relief, this technique is useful.

1. Prepare the sheet: Ensure the repositioning sheet is properly placed underneath the patient.
2. Position the patient for the roll: Bend the patient's knee furthest from you and place their arm closest to you across their chest. Place the other arm by their side.
3. Roll: Grasp the far side of the repositioning sheet. Use your body weight and legs to pull the patient gently toward you, rolling them onto their side. Utilize pillows or wedges behind the patient's back and between their knees to maintain the side-lying position.

Repositioning Sheets: A Comparison of Types

Feature	Tubular Slide Sheet	Flat Slide Sheet	Slide Sheet with Handles
Material	Low-friction nylon or polyester	Low-friction nylon or polyester	Low-friction material, often reinforced
Design	Seamless, closed loop	Flat, open sheet	Flat sheet with multiple straps or handles
Best For	Two-person moves, turning in bed, complex maneuvers	Smaller shifts, side-to-side transfers	Heavy patients, complex lifts, or when precise control is needed
Caregiver Effort	Very low, as surfaces glide easily	Low, requires more direct pulling	Very low, handles provide a secure grip
Key Benefit	High-efficiency gliding action	Versatility for various shifts	Maximum control and caregiver safety

Important Safety Best Practices

• Communicate: Always talk to the patient, telling them what you are doing before you do it.
• Prioritize Body Mechanics: Bend at your knees, not your back. Keep the patient and the sheet close to your body when moving.
• Assess Patient Mobility: Understand the patient's ability to assist. For patients with very limited mobility, always use a two-person assist.
• Smooth Surfaces: Always smooth out any wrinkles in the bed sheets and the repositioning sheet to prevent pressure points that can cause skin sores.
• Regular Repositioning: Repositioning should be done on a regular schedule (typically every two hours) to prevent pressure ulcers, especially for bedridden individuals.
• Infection Control: Use single-patient repositioning sheets to prevent cross-contamination in shared care settings.

Conclusion

Mastering how to use a repositioning sheet is a vital skill that enhances the safety, comfort, and dignity of both the patient and the caregiver. By understanding the different types of sheets, following correct procedures, and adhering to best practices for safe handling, you can perform daily care tasks with confidence and greatly reduce the risk of injury. The right tools and techniques ensure that repositioning is a smooth, efficient, and pain-free experience for everyone involved. For additional safety resources, the Occupational Safety and Health Administration (OSHA) offers guidelines on safe patient handling practices.

Frequently Asked Questions

How often should I reposition a bedridden patient?

A bedridden patient should typically be repositioned at least every two hours to prevent the formation of pressure ulcers. However, the exact frequency can depend on the patient's individual needs and skin tolerance.

Can one person use a repositioning sheet alone?

A single caregiver can use a repositioning sheet for certain maneuvers, such as turning a cooperative patient onto their side or making a small adjustment. For moving a patient up in bed or handling a heavier, less mobile patient, a two-person assist is strongly recommended for safety.

What is the difference between a repositioning sheet and a transfer board?

A repositioning sheet is used to slide a patient within the bed itself. A transfer board is a rigid piece of equipment used to bridge a gap between two surfaces, like a bed and a wheelchair, to help a patient slide across.

How do I clean a repositioning sheet?

Cleaning instructions vary by manufacturer. Most repositioning sheets are machine washable, but some disposable or single-patient-use sheets should be discarded after they become soiled or are no longer needed. Always check the specific product's care instructions.

Is a repositioning sheet breathable?

While some repositioning sheets are designed to be breathable, others are not. Products intended to remain under a patient for longer periods, such as disposable or breathable varieties, are designed with moisture management in mind to reduce the risk of skin breakdown.

What if a patient is too heavy to move with a repositioning sheet?

For bariatric patients or those who require significant assistance, a mechanical patient lift or other advanced equipment may be necessary. For safety, never attempt a repositioning maneuver that is beyond your physical capabilities or requires more assistance than you have available.

Can I leave a repositioning sheet under the patient?

Most repositioning sheets are designed to be removed immediately after a maneuver. Leaving a slippery slide sheet under a patient poses a fall risk. Some durable or breathable repositioning sheets, however, can be left under a patient if designed for that purpose, but it is important to smooth out all wrinkles.