A person who is bedridden has limited or no ability to move independently, placing them at high risk for serious health complications. The primary goal of turning and repositioning is to maintain comfort and prevent these adverse health issues. Prolonged immobility can quickly lead to tissue damage and a decline in overall well-being. Regular changes in body position are a fundamental part of the care plan.
Establishing the Standard Repositioning Schedule
The long-standing standard protocol for repositioning a bedridden patient is a minimum of every two hours, often referred to as the “two-hour rule.” This frequent schedule is designed to relieve sustained pressure over bony areas like the hips, sacrum, and heels, which are particularly susceptible to injury when compressed against a surface. Caregivers should systematically alternate the patient’s position, rotating between the left side, right side, and back, ensuring that the previously compressed areas are completely offloaded.
This two-hour interval serves as a baseline, but many factors necessitate a more frequent schedule, sometimes hourly. Patients with existing skin damage, frailty, poor circulation, or those on certain pressure-reducing surfaces may need more aggressive, individualized repositioning plans. Frequency should be adjusted based on tissue tolerance, gauged by monitoring how quickly redness over a bony prominence disappears after pressure is relieved.
Individuals who are chair-bound require more frequent repositioning than those in bed because the seated position concentrates pressure on a smaller area, specifically the ischial tuberosities (sit bones). For patients seated in a chair who cannot perform weight shifts, repositioning should occur at least every hour. This can involve a complete change of position or utilizing the chair’s tilt function to at least a 30-degree angle for five minutes to reoxygenate compressed tissue.
Preventing Pressure Injuries and Other Complications
The most recognized consequence of prolonged immobility is the development of pressure injuries, also known as bedsores or pressure ulcers. These injuries occur when sustained pressure on the skin and underlying tissue exceeds the normal capillary closing pressure (approximately 32 millimeters of mercury). This restricted blood flow causes localized ischemia, or lack of oxygen, which ultimately leads to cell death and tissue breakdown.
Regular repositioning is the primary mechanical intervention used to prevent this process by redistributing pressure and restoring blood flow. Beyond pressure injuries, turning helps mitigate other serious health risks. Changing positions helps boost overall circulation, which reduces the risk of blood clots.
Repositioning also promotes enhanced respiratory function by preventing fluid from settling in the lungs, reducing the risk of pneumonia. Moving the patient prevents muscles and joints from becoming stiff, which helps avoid painful joint contractures that limit range of motion.
Safe Techniques for Repositioning
Safe repositioning requires using techniques that minimize friction and shear forces, which are major contributors to skin damage. Friction occurs when the skin rubs against a surface, and shear happens when tissue layers slide over each other, often caused by the patient sliding down in bed. Caregivers should always lift the patient rather than drag them across the sheets to prevent this damage.
A draw sheet, a small sheet placed under the patient’s torso, is an effective aid for lifting and moving the person with minimal dragging. Proper body mechanics for the caregiver are important, involving bending at the knees instead of the waist and shifting weight from the back foot to the front foot during the move. This technique protects the caregiver’s back while ensuring a smooth, controlled movement.
When positioning the patient on their side, the recommended technique is the 30-degree lateral incline. This slight tilt avoids placing direct pressure on the hip bone (greater trochanter) and the sacrum. Pillows or foam wedges should be used to maintain this position, supporting the patient’s back and ensuring their heels are suspended off the mattress to eliminate pressure. The turning process is also the ideal time for a caregiver to inspect the patient’s skin for any signs of redness or breakdown, allowing for immediate adjustments to the care plan.