Repositioning an immobile patient, often referred to as turning, is a fundamental practice in long-term care. It serves as a primary defense against complications arising from prolonged immobility, supporting patient comfort and safety. This routine movement is essential for maintaining skin integrity and promoting overall health for individuals who are bedridden or have limited mobility. Establishing the correct schedule and technique is paramount to effective patient care.
The Standard Repositioning Schedule and Rationale
The standard frequency for turning patients who are unable to move themselves is at least every two hours. This schedule addresses the physiological response of tissue to sustained pressure, the root cause of pressure injuries, commonly known as bedsores or decubitus ulcers. Sustained pressure compresses small blood vessels, leading to localized blood flow restriction called ischemia.
Tissue can tolerate pressure for a limited duration before this lack of blood flow causes cellular damage. The two-hour interval is considered the maximum safe period to relieve pressure and allow for reperfusion, where blood flow returns to the compressed area. Regular turning also benefits respiratory function by helping to mobilize lung secretions and promoting lung expansion, which reduces the risk of complications like atelectasis and pneumonia.
Factors Requiring Adjusted Turning Schedules
The two-hour schedule serves as a baseline, but the optimal turning frequency is highly individualized and must be adjusted based on a patient’s specific risk profile. Clinicians use validated risk assessment tools, such as the Braden Scale, to quantify a patient’s vulnerability to skin breakdown based on factors like sensory perception, moisture, activity, mobility, nutrition, and friction/shear. A patient with a high-risk score on this assessment may require repositioning more frequently than the standard recommendation.
Skin integrity is another factor; any existing redness that does not blanch (turn white) when pressed, or the presence of a stage one pressure injury, necessitates immediate and more frequent pressure relief. A patient’s ability to perceive discomfort or shift their own weight also influences the schedule, as those with impaired sensation or mobility are at greater risk and require closer attention. Furthermore, the use of specialized support surfaces, such as advanced pressure-redistributing mattresses or low-air-loss beds, can sometimes safely extend the turning interval beyond two hours. These specialized surfaces work to immerse and envelop the patient, distributing pressure over a larger area, but this adjustment must always be determined by a health professional.
Essential Steps for Safe Patient Turning
The physical technique used for repositioning is as important as the frequency to ensure patient safety and comfort. Caregivers should utilize specialized equipment like draw sheets or slide sheets to help lift and move the patient rather than dragging them. Lifting prevents friction and shear forces, which can damage the skin’s surface and underlying tissue.
When turning an immobile patient, the goal is to achieve the correct body alignment that offloads pressure from bony prominences. The recommended posture is the 30-degree lateral incline position, achieved by placing the patient slightly on their side, supported by pillows or wedges. This gentle angle avoids placing the patient directly onto a major bony area, such as the hip bone (greater trochanter) or sacrum, allowing the body weight to rest on muscle mass instead. Following the turn, documentation is required, recording the exact time of the turn, the new position, and a brief assessment of the skin condition, particularly over pressure points. Caregiver safety requires the use of proper body mechanics, such as bending at the knees and engaging core muscles, to prevent back injuries during the physical process of lifting and turning.