For individuals who are bedridden, the standard of care is to reposition them at least every two hours. This frequent turning is a crucial intervention to prevent pressure injuries, also known as bedsores or pressure ulcers, which are areas of damaged tissue caused by constant pressure on the skin. By regularly changing a patient's position, pressure is relieved from weight-bearing areas, ensuring proper blood flow and keeping the skin healthy.
Why Frequent Repositioning is Essential
Infrequent movement and prolonged pressure can lead to severe health consequences. When pressure is not alleviated, it compresses the blood vessels, limiting blood flow and oxygen to the tissue. This can cause skin breakdown and the rapid development of pressure injuries, which can lead to serious infections like sepsis. Beyond preventing bedsores, regular repositioning offers several other critical health benefits:
- Improved Circulation: Shifting positions helps to improve blood flow throughout the body, preventing issues like deep vein thrombosis (DVT), where blood clots form in the legs due to poor circulation.
- Preventing Respiratory Complications: Changes in position can help prevent fluid from building up in the lungs, which is a common cause of pneumonia in bedridden patients.
- Maintaining Joint and Muscle Health: Without movement, muscles can weaken and atrophy rapidly. Joints can also become stiff and contract, which can be irreversible. Repositioning helps maintain range of motion and muscle integrity.
- Enhanced Comfort: Simply shifting position can greatly increase a patient’s comfort, which also has a positive impact on their mental and emotional well-being.
Individualizing the Repositioning Schedule
While the two-hour standard is a good starting point, the ideal frequency for repositioning must be individualized to each patient's specific needs. A healthcare provider can help determine the best schedule based on several factors:
- Tissue tolerance: Some individuals have more fragile skin or are prone to skin breakdown. A caregiver can monitor the skin for redness over bony areas and, if it appears quickly, repositioning may be needed more often.
- Level of mobility: A patient who can assist with their own repositioning may not need help as frequently as someone who is completely immobile.
- General medical condition: Overall health, nutrition, and underlying medical conditions like diabetes or poor circulation affect skin integrity and wound healing.
- Type of mattress: The use of a specialized pressure-redistribution mattress, like an air overlay or viscoelastic foam mattress, can sometimes allow for longer intervals between manual turns. However, this should only be done under a doctor's recommendation.
A Step-by-Step Guide to Safe Repositioning
Proper technique is crucial for protecting both the patient's skin and the caregiver's back. The following steps, often involving a partner, can help ensure safe repositioning:
- Prepare the patient: Explain what you are going to do and encourage them to help if they can.
- Use a draw sheet: Place a folded draw sheet or slide sheet underneath the patient to reduce friction and make movement easier. Never drag the patient by their limbs.
- Use proper body mechanics: Stand with your feet shoulder-width apart, knees bent, and back straight. Use your legs to do the work.
- Roll the patient: Gently roll the patient to their side, pushing from the hip and shoulder closest to you.
- Position for support: Place pillows or foam wedges under their back to keep them on their side. A pillow between the knees and ankles prevents bony areas from rubbing together. Ensure the heels are floated off the mattress by placing a pillow under the calves.
- Document the turn: Keep a record of the time and position to maintain a consistent schedule.
The 'Rule of 30' Technique
When positioning a patient on their side, a specific method called the “Rule of 30” can be very effective. This technique positions the patient at a 30-degree lateral incline, which minimizes pressure on the sacrum and hips. The head of the bed should be elevated no more than 30 degrees to prevent shearing, which is when the skin is dragged against the bed surface.
Repositioning in a Seated Position
For bedridden patients who spend time sitting in a chair or wheelchair, repositioning is also vital but needed more frequently. The recommended schedule for seated individuals is to shift weight every 15 minutes if they can do so independently, or to be repositioned every hour with assistance. A specialized pressure redistribution cushion should always be used to help distribute weight evenly.
Comparison of Standard Repositioning vs. Specialized Care
| Feature | Standard Repositioning | High-Risk or Specialized Care |
|---|---|---|
| Frequency | Every 2 hours, including overnight. | More frequent (e.g., hourly), especially during the day. |
| Patient Risk Level | Standard, general risk factors for pressure injuries. | Elevated risk due to factors like existing wounds, poor circulation, malnutrition, or advanced age. |
| Equipment Used | Pillows, wedges, draw sheets. | Pressure redistribution mattresses (e.g., air overlay, foam), heel protectors, specialized cushions. |
| Positioning Technique | Alternating between back and both sides. | May require more varied and subtle positioning to avoid specific tender areas or existing wounds. |
| Nighttime Repositioning | Consistent with the daytime schedule, every 2 hours. | May be adjusted to every 3-4 hours on pressure-relieving surfaces to improve sleep, but only with a doctor's approval. |
| Observation | Regular skin checks during repositioning. | Meticulous, daily skin checks for any signs of redness, discoloration, or swelling. |
Conclusion
The question of how often should you move someone who is bedridden is not a one-size-fits-all answer, but rather a guideline that must be customized to the individual's needs. While the every-two-hours rule is a critical starting point for preventing pressure injuries, effective care depends on consistent monitoring, proper technique, and individual assessment. For caregivers, the combination of a consistent schedule, specialized equipment when needed, and diligent skin observation is the most effective strategy for ensuring the safety, comfort, and overall health of a bedridden person.
For further reading on wound care and patient positioning, consider this resource:
- National Pressure Ulcer Advisory Panel (NPUAP) Position Statement on Repositioning (Note: The organization is now called the National Pressure Injury Advisory Panel, but some content may reference the old name.)
