When should immobile residents be repositioned? An essential caregiver’s guide

According to the Agency for Healthcare Research and Quality, consistent repositioning is a core strategy for preventing pressure ulcers in bedridden or chair-bound individuals. This guide provides a comprehensive overview of when should immobile residents be repositioned to ensure their safety and well-being.

Quick Summary

For immobile residents, the general guideline is to reposition those in bed at least every two hours and those seated in a chair every hour. This schedule should be adjusted based on a resident's individual risk factors, skin condition, and comfort level, as higher-risk individuals may require more frequent turning.

Key Points

• Standard Schedule: Reposition bedridden residents every two hours and seated residents every hour to prevent pressure injuries.

• Individualized Care: High-risk residents with conditions like diabetes or poor nutrition may require more frequent repositioning.

• Reduce Shear and Friction: Always use a draw sheet to lift and move residents, rather than dragging them across the surface.

• Inspect Skin Daily: Monitor skin for signs of redness, warmth, or non-blanching erythema, especially over bony prominences, and adjust the schedule as needed.

• Utilize Equipment: Use pressure-relieving mattresses, wedges, and pillows to distribute weight and provide proper support.

• Document Everything: Maintain a clear repositioning schedule and document turns and skin observations to ensure consistent and effective care.

The Crucial Importance of Repositioning Immobile Residents

For individuals with limited mobility, consistent and correct repositioning is not merely a comfort measure—it's a critical component of preventative care. Neglecting a repositioning schedule can lead to serious and painful health complications, most notably pressure ulcers, also known as bedsores. These injuries are caused by unrelieved pressure on the skin that restricts blood flow and damages underlying tissue.

Health Risks of Prolonged Immobility

Beyond pressure ulcers, prolonged immobility poses several other health risks for seniors, which proper repositioning helps mitigate:

• Compromised Circulation: Stagnant blood flow increases the risk of dangerous blood clots, such as Deep Venous Thrombosis (DVT), particularly in the legs.
• Respiratory Complications: Without regular changes in position, fluids can accumulate in the lungs, increasing the risk of pneumonia.
• Muscle Atrophy and Joint Contractures: Lack of movement leads to rapid muscle weakening and stiffness in joints, which can become permanently frozen in a contracted position.
• Poor Skin Integrity: The risk of friction and shear injuries, where skin is torn or damaged, increases significantly without careful repositioning using proper techniques.

Establishing the Correct Repositioning Schedule

Determining when should immobile residents be repositioned depends on their specific environment and individual risk factors. While there are standard guidelines, care plans must be personalized.

Standard vs. High-Risk Repositioning

Factor	Standard-Risk Residents	High-Risk Residents
In Bed	Reposition at least every 2 hours.	Reposition more frequently, potentially every hour, especially if skin redness appears.
In Chair	Reposition or assist with weight shifts at least every hour.	Reposition every 15-30 minutes, or use a pressure-redistribution cushion for consistent pressure relief.
Skin Condition	Monitor skin daily for early signs of redness.	Inspect skin closely and frequently, often at every repositioning, and report any changes immediately.

What Makes a Resident High-Risk?

Several factors increase an individual's susceptibility to pressure ulcers, necessitating a more frequent repositioning schedule. These include:

• Poor Nutrition and Hydration: Insufficient protein and fluid intake can weaken skin tissue, making it more vulnerable to breakdown.
• Incontinence: Exposure to moisture from urine or stool can soften the skin, making it more prone to damage.
• Medical Conditions: Diabetes and vascular disease, which affect blood flow, are significant risk factors.
• Sensory Perception: Residents with reduced sensation may not feel the discomfort or pain that signals the need to change position.

Best Practices for Safe and Effective Repositioning

Executing the repositioning process safely is vital to prevent injury to both the resident and the caregiver. The use of proper techniques and equipment minimizes the risk of friction, shear, and caregiver strain.

Step-by-Step Repositioning in Bed

1. Preparation: Explain the process to the resident, even if they have cognitive impairment. Raise the bed to a comfortable working height and lock the wheels. Place a draw sheet under the resident, extending from their shoulders to their thighs.
2. Positioning the Resident: With a helper, stand on opposite sides of the bed. Roll the resident onto their side, towards you. Place pillows or wedges for support, ensuring bony prominences are cushioned.
3. Moving Up the Bed: Using the draw sheet, lift rather than drag the resident to avoid skin shearing. One person grasps the sheet near the resident's shoulders, and the other near the hips. On a count of three, lift and move the resident together.
4. Final Alignment: After repositioning, check that the resident's body is in proper alignment with their spine straight. Use additional pillows to support limbs and ensure knees and ankles do not press against each other.

Techniques for Seated Residents

• Weight Shifts: Encourage residents who can to perform small weight shifts every 15 minutes by pushing up with their arms or leaning from side to side.
• Chair-Side Repositioning: For those unable to shift independently, caregivers should assist with repositioning at least every hour, using a draw sheet or sling to gently lift and move the resident's hips and buttocks.

Essential Equipment and Aids

Using the right tools makes repositioning safer and more comfortable.

• Draw Sheets: Used to lift and move a resident without pulling directly on their skin.
• Pressure-Relieving Mattresses and Cushions: These specialty surfaces distribute pressure more evenly across the body and are available in foam, air, or gel variants.
• Positioning Wedges and Pillows: Help maintain proper alignment and support for limbs and the back during side-lying positions.
• Patient Lifts: Mechanical lifts are necessary for individuals who are too heavy to be moved safely by a single caregiver, preventing strain and injury.

Documenting and Monitoring the Repositioning Plan

Effective care requires meticulous tracking and assessment. A written repositioning schedule is essential, detailing the times and positions for each turn. This ensures consistency and allows caregivers to monitor for any skin changes effectively.

• Create a Schedule: Post a turning schedule in a visible location for all caregivers.
• Inspect Skin Regularly: Check the resident’s skin during each repositioning session, paying close attention to bony areas like the tailbone, hips, heels, and elbows.
• Document Changes: Record the times of repositioning and any observations of skin redness, warmth, or non-blanching erythema. This documentation helps the healthcare team track the effectiveness of the care plan.

Conclusion

Knowing when should immobile residents be repositioned is a fundamental aspect of high-quality senior care. By adhering to established guidelines, individualizing schedules based on risk factors, and utilizing proper techniques and equipment, caregivers can significantly reduce the risk of pressure ulcers and other complications. This proactive approach ensures not only the resident's physical health but also their comfort, dignity, and overall quality of life. For more detailed information on preventing pressure ulcers, refer to the Mayo Clinic's guide.

Frequently Asked Questions

How often should an immobile person be repositioned in bed?

A standard recommendation for a bedridden immobile person is to be repositioned at least every two hours. However, this frequency may need to be increased for individuals at a higher risk for developing pressure ulcers, such as those with poor circulation or fragile skin.

How often should a resident in a wheelchair be repositioned?

Residents who are seated for extended periods, such as in a wheelchair, should be repositioned or assisted with weight shifts more frequently. A general guideline is to assist with repositioning at least every hour, or every 15 to 30 minutes if they are able to perform weight shifts independently.

What are pressure ulcers and how does repositioning help prevent them?

Pressure ulcers (also known as bedsores) are injuries to the skin and underlying tissue resulting from prolonged pressure on the skin. Repositioning helps by relieving pressure from specific areas, restoring blood flow, and allowing oxygen and nutrients to reach the tissue, thus preventing skin breakdown.

What equipment is needed to safely reposition an immobile resident?

Essential equipment includes a draw sheet (or slide sheet) for lifting, pillows and foam wedges for supporting limbs and maintaining alignment, and potentially a pressure-relieving mattress or cushion for long-term bed or chair use. For heavy residents, a mechanical patient lift may be necessary to prevent caregiver injury.

How can I tell if a resident needs to be repositioned more frequently?

Look for warning signs such as persistent redness or discoloration on the skin over bony areas, increased warmth, tenderness, or complaints of discomfort. If these signs are present, the current repositioning schedule is likely insufficient and needs to be adjusted.

Is it okay to use a donut-shaped cushion for repositioning?

No, donut-shaped cushions are generally not recommended. They can restrict blood flow to the tissue surrounding the opening, potentially increasing the risk of pressure ulcers rather than preventing them.

What is the best technique to avoid friction when repositioning?

To avoid skin-damaging friction and shearing, use a draw sheet or lift sheet. By using the sheet to lift and move the resident, you prevent the skin from dragging against the bed or chair surface. Never pull directly on the resident's limbs or body to move them.