Individuals who are unable to change their own body position due to a health condition or injury are considered bed-bound. This lack of self-initiated movement places sustained pressure on certain areas of the body, which can compromise tissue health. Repositioning is a foundational element of preventative care in this population, as it involves manually shifting the person’s weight to redistribute pressure and maintain circulation. Regular movement is necessary to prevent health complications that arise from prolonged immobility and to promote overall skin integrity.
The Primary Standard for Repositioning
The standard recommendation for bed-bound individuals is to reposition them at least every two hours. This standard, often referred to as the “two-hour rule” or Q2H, is based on clinical data suggesting that most tissues can tolerate pressure for approximately 120 minutes before irreversible damage begins. Following this schedule helps relieve pressure points, allowing blood flow to restore oxygen and nutrients to the affected tissue.
For residents who are chair-bound or spend significant time sitting, the standard is to shift their weight or be repositioned every hour. If they are capable of small self-shifts, this frequency may increase to every 15 minutes. Sitting places a high concentration of pressure on the bony prominences of the buttocks and tailbone, making these areas highly susceptible to injury. These schedules represent the minimum frequency for pressure relief and serve as the starting point for individualized care plans.
Why Repositioning is Essential
Prolonged pressure on the skin and soft tissues leads to the development of pressure injuries, historically known as bedsores. This damage occurs when pressure exerted between a bony prominence and the support surface impedes blood flow. When blood flow is impeded, the tissue experiences ischemia—a lack of oxygen and nutrient supply to the cells.
If the pressure is not relieved, the oxygen-deprived cells enter a state of cellular hypoxia, leading to cell death and necrosis. Tissues closest to the bone, such as muscle and subcutaneous fat, are the most vulnerable and may be damaged before visible injury appears on the skin. Pressure injuries are classified in stages, progressing from non-blanchable redness to full-thickness tissue loss. Repositioning interrupts this damaging process, allowing blood flow to return before cellular damage becomes irreversible.
Factors Influencing Repositioning Frequency
While the two-hour rule is the standard, the actual repositioning schedule must be tailored based on individual risk factors. Standardized assessment tools, such as the Braden Scale, are utilized by healthcare professionals to determine a resident’s specific risk level for tissue damage.
This scale evaluates six subcategories: sensory perception, activity, mobility, moisture, nutrition, and friction/shear. Residents with a high-risk score, such as those with very limited mobility, require more frequent repositioning. For these individuals, the schedule may be accelerated to every 90 minutes or even every hour to ensure adequate pressure relief. The care plan is also adjusted based on the resident’s current skin condition, existing injuries, and tolerance to position changes.
Safe Repositioning Techniques
The primary goal when repositioning is to minimize friction and shear, two mechanical forces that damage the skin. Friction is the force created when two surfaces rub together, stripping away the top layer of skin. Shear occurs when the skin remains stationary but the underlying tissue moves, often when a person slides down in bed, stretching blood vessels.
Caregivers should use assistive devices, such as draw sheets or slide sheets, when moving a resident up in bed. These tools allow the person to be lifted rather than dragged, significantly reducing friction against the mattress. When turning a resident, the preferred position is the 30-degree lateral side-lying position, which avoids placing direct pressure on the hip bone.
Supportive devices, including pillows and foam wedges, are necessary to maintain the new position and offload bony prominences. Heels are particularly vulnerable and must be completely suspended off the mattress using a pillow or specialized boot. Furthermore, the head of the bed should be kept as flat as possible, ideally no higher than a 30-degree elevation, to prevent sliding and damaging shear forces.