Repositioning an immobile person is a fundamental care practice aimed at preventing pressure injuries, often called bedsores. These injuries are localized areas of damage to the skin and underlying soft tissue caused by sustained pressure that restricts blood flow. Since tissue can begin to die within hours, a consistent repositioning schedule is necessary to redistribute weight and allow for tissue recovery.
Establishing the Standard Repositioning Schedule
The standard guideline for a person confined to bed is to reposition them at least every two hours. This frequency relieves pressure before sustained compression leads to tissue ischemia. Pressure exceeding the arterial capillary pressure, typically around 32 millimeters of mercury (mm Hg), impairs blood flow and causes tissue damage.
The two-hour interval ensures pressure is relieved from bony prominences before damage begins. This is a baseline, and the actual frequency must be individualized based on specific risk factors, such as general medical condition and skin tolerance. Frail patients or those with poor circulation may require more frequent turning.
For individuals seated in a chair or wheelchair, the recommended repositioning schedule is more frequent due to the higher pressure exerted on the buttocks and tailbone. A person unable to shift their own weight should be repositioned every hour. Encouraging a weight shift to offload pressure for one to two minutes every 30 minutes is also beneficial, if possible.
Specialized support surfaces, such as pressure-reducing or alternating air mattresses, can modify the required turning schedule. These devices redistribute pressure and may allow the interval to be extended to every three or four hours for some patients. No support surface entirely eliminates the need for repositioning; the devices simply complement the manual turning schedule.
Safe Techniques for Movement and Alignment
Proper technique is necessary to move an immobile person without causing friction or shear, which damage the skin more quickly than direct pressure. Friction occurs when skin rubs against a surface, while shear happens when skin layers slide over each other, stretching blood vessels. To prevent both, the person must be lifted, not dragged, during any position change.
Using a draw sheet, a small sheet placed beneath the person spanning from the shoulders to the thighs, is the safest way to move them. Caregivers grip the sheet tightly on both sides and use their leg muscles to gently lift and slide the person, minimizing skin trauma. Communication throughout the process, explaining the steps, ensures cooperation and reduces anxiety.
When positioning the person on their side, the 30-degree side-lying position is preferred over a full 90-degree turn. This slight tilt directs weight onto the fleshy areas of the hip and buttocks, relieving pressure from the vulnerable greater trochanter and sacrum. Pillows or foam wedges must be used to maintain this angle. One pillow is placed along the back to keep them tilted, and another is placed between the knees and ankles to prevent bony surfaces from resting against each other.
Ensure the heels are suspended or off-loaded, as they are a common site for injury. A small pillow or pad placed beneath the calves elevates the heels so they hang freely above the mattress. When the head of the bed is elevated for comfort or feeding, it should be kept at no more than 30 degrees to minimize the shearing force that causes the skin over the sacrum to slide down.
Recognizing and Managing Skin Risk Factors
The effectiveness of any repositioning schedule is confirmed by daily skin checks, ideally performed with every position change. The skin must be inspected over all bony prominences, including the tailbone, hips, heels, shoulder blades, and the back of the head.
The key early sign of a developing pressure injury is non-blanchable redness—a red, purple, or blue discolored patch of intact skin that does not turn white when light pressure is applied. If the area is warm, swollen, or feels hard or spongy, underlying tissue damage is likely present. If a reddened area blanches and the color returns within 30 minutes of pressure relief, the tissue has recovered.
Several internal and external factors increase a person’s risk and may require a more aggressive repositioning plan. Environmental factors include excessive moisture from incontinence, which softens the skin and makes it more susceptible to breakdown. Internal factors like poor nutrition, dehydration, and medical conditions affecting blood flow, such as diabetes, reduce the skin’s tolerance for pressure.
If a non-blanchable red area does not improve within 24 to 48 hours of consistent pressure relief, contact a healthcare professional. Immediate medical attention is necessary if signs of infection appear, such as a fever, pus draining, a foul odor, or if the sore exposes deeper structures like muscle or bone. These symptoms indicate a serious, rapidly progressing infection requiring urgent treatment.