Turning a patient with limited mobility is a fundamental practice in long-term care and hospital settings. This procedure, often called repositioning, involves carefully changing a person’s body position while they are in bed or a chair. Executing this task correctly is necessary for maintaining the patient’s well-being and preventing serious complications.
The Critical Rationale for Repositioning
Repositioning a patient every two hours prevents pressure injuries, commonly referred to as bedsores or decubitus ulcers. When soft tissue is compressed between a bony prominence and an external surface, the pressure can exceed the capillary closing pressure (approximately 32 mm Hg). This sustained compression obstructs blood flow, leading to ischemia and a lack of oxygen and nutrients to the tissue.
Without regular relief, this lack of blood flow causes localized tissue damage and eventual cell death, which can manifest as a pressure injury within hours. The two-hour interval is the traditional protocol, ensuring no single area is subjected to continuous pressure for an extended duration. Bony areas are at the highest risk because they lack the cushioning of fat and muscle.
The most vulnerable sites for pressure injuries include:
- The sacrum and coccyx
- The heels
- The hips
- The elbows
- The shoulder blades
- The back of the head
Damage is further compounded by friction (the rubbing of skin against a surface) and shear (the separation of skin layers from underlying tissue). Repositioning redistributes pressure, allowing blood flow to return to compressed areas and minimizing the effects of friction and shear.
Essential Preparation and Safety Checks
Proper preparation and safety checks are necessary before repositioning to protect both the patient and the caregiver. The first step involves gathering necessary equipment, including a draw sheet or lift sheet, pillows, foam wedges, and any prescribed transfer aids. The bed should be adjusted to a height that allows the caregiver to work comfortably without excessive bending or reaching, maintaining safe body mechanics.
The wheels of the bed must be locked securely to prevent movement during the turn. Before moving the patient, perform a thorough skin assessment, focusing on the bony prominences that were bearing weight. Check the skin for discoloration, persistent redness, warmth, or hardness, as these are early indicators of tissue damage.
Specifically, look for non-blanchable erythema (redness that does not turn white when light pressure is applied), which signals a Stage 1 pressure injury. The draw sheet should be placed beneath the patient, extending from the shoulders to the hips. This tool is used to lift and move the patient rather than dragging them, minimizing friction and shear forces on the skin during movement.
Step-by-Step Patient Repositioning Techniques
Communication with the patient is the first step, explaining the steps clearly and encouraging them to assist if they are able. The primary technique involves using the draw sheet for a controlled lift and turn, rather than pulling on the patient’s limbs. The caregiver should stand on the side toward which the patient will be turned and gently move the patient toward the opposite side before the turn.
The preferred position for a bedridden patient is the 30-degree lateral incline, often called the “Rule of 30,” which is safer than a full 90-degree side-lie. To achieve this, the patient is tilted approximately 30 degrees from a flat-on-back position. Pillows or foam wedges are placed behind the back and between the knees and ankles to maintain the position. This angle offloads pressure from the hip bone by distributing the weight across a broader surface area of the patient’s back.
For patients with a suspected or confirmed spinal injury, the log-roll technique must be used to keep the head, torso, and legs perfectly aligned, turning the patient as a single unit. Regardless of the technique, ensure the patient’s ankles, knees, and elbows are not resting directly on top of each other, which creates new points of excessive pressure. The patient’s head and neck must be kept in alignment with the spine, and the arms should not be trapped under the weight of the body.
Maintaining the Repositioning Schedule
Strict adherence to the two-hour schedule ensures consistent pressure relief and prevents new pressure injuries. This schedule must be maintained around the clock, including throughout the night. A simple method for tracking these movements is using a chart or log that documents the exact time of the turn and the specific position the patient was placed in.
This documentation prevents missed turns and ensures the patient does not spend too long in any single position. While the two-hour interval applies to patients in bed, those who sit in a chair require more frequent repositioning. Seated patients should shift their weight every 15 minutes independently, or be repositioned by a caregiver at least every hour. This adjustment accounts for the higher pressure placed on the buttocks and tailbone when sitting upright.