A person is considered bed-bound when they require assistance to move or reposition themselves while lying down. Consistent and planned repositioning is a foundational practice in safe caregiving for these individuals. This proactive movement mitigates the risks associated with prolonged immobility and sustained pressure on the body.
The Standard Schedule for Repositioning
The widely accepted baseline for repositioning a bed-bound person is a minimum of every two hours, often referred to as the two-hour rule. This schedule is maintained consistently throughout both daytime and nighttime hours to provide continuous relief. The physiological basis for this specific interval relates to the duration of sustained pressure the body can tolerate before tissue damage begins to occur. In individuals who are at risk, pressure that exceeds the capillary closing pressure in the skin can lead to localized lack of blood flow, known as ischemia. Research suggests that two hours represents the maximum duration before this lack of circulation initiates tissue injury.
What Repositioning Prevents
The primary complication that consistent repositioning aims to prevent is the development of pressure injuries, historically known as bedsores. A pressure injury is defined as localized damage to the skin and the underlying soft tissue, typically occurring over a bony prominence. This damage results from sustained pressure combined with shear or friction forces that compromise blood flow to the area. When blood flow is restricted, oxygen and nutrients cannot reach the tissue, leading to cell death and the formation of an open sore.
The severity of these injuries is categorized using a staging system, ranging from Stage 1, which involves non-blanchable redness of intact skin, to Stage 4, which includes full-thickness tissue loss. Preventing the initial injury is simpler than treating even a Stage 1 injury, as these wounds can be painful, difficult to heal, and significantly increase the risk of serious infection. Repositioning disrupts the continuous pressure cycle, allowing blood flow to restore to the compressed areas and maintaining tissue viability.
Patient Factors That Change the Schedule
While the two-hour standard provides a framework, effective care requires tailoring the schedule based on individual patient factors and specific risk assessments. A patient who exhibits existing redness or non-blanching erythema on their skin may require movement every hour, as this is an early sign of tissue damage. The ability of the skin to recover is significantly influenced by underlying medical conditions.
Individuals with diabetes, poor peripheral circulation, edema, or malnutrition may have compromised tissue integrity and slower healing capacity, necessitating more frequent checks and adjustments. Malnutrition, specifically protein deficiency, hinders the body’s ability to repair damaged tissue, increasing vulnerability to skin breakdown. The use of specialized pressure-relieving mattresses or low-air-loss beds can distribute pressure more effectively, potentially allowing a slight extension of the interval, but these devices do not eliminate the need for regular repositioning. If a patient reports discomfort or pain before the scheduled time, that immediate sensation serves as an indication to change their position without delay.
Safe Techniques for Moving a Bed Bound Person
Repositioning must be executed using specific techniques to ensure the safety of both the patient and the caregiver while minimizing skin trauma. The proper method involves utilizing lifting aids, such as a draw sheet or lift sheet, which are placed beneath the patient’s torso and hips. Caregivers should use this sheet to gently lift and move the patient across the bed surface rather than dragging or pulling them. This technique is designed to eliminate friction and shear forces, which are major contributors to skin breakdown.
When turning a person onto their side, the recommended practice is to use the 30-degree lateral inclined position. This angle prevents the patient from lying directly on the greater trochanter, which is the prominent bony point of the hip. Direct, sustained pressure on this area can quickly lead to injury, so using pillows or foam wedges to maintain the 30-degree tilt is beneficial. During every position change, the caregiver should perform a quick but thorough skin assessment, particularly inspecting bony areas like the heels, tailbone (sacrum), hips, and shoulder blades. Checking these pressure points for any changes in color, temperature, or firmness ensures that signs of early damage are identified immediately.