When a person is confined to a bed for an extended time, physical immobility introduces significant health challenges. Immobility prevents the natural shifts in body weight that protect underlying tissues from constant strain. Repositioning the body is a fundamental aspect of care that helps maintain skin integrity and promote better circulation. This movement preserves the patient’s health and comfort during prolonged bed rest.
Standard Frequency Guidelines
The widely accepted baseline for repositioning bedridden patients is at least every two hours. This standard, often called the “two-hour rule,” serves as the default protocol across numerous healthcare settings, including hospitals and long-term care facilities. The goal of this schedule is to regularly redistribute pressure across the body’s surface. Consistent repositioning ensures that no single area sustains prolonged compression that could compromise tissue health.
Preventing Pressure Injuries
The structured repositioning schedule directly combats the formation of pressure injuries, also known as bedsores. These injuries begin when external pressure on the skin exceeds the internal pressure of the capillaries, typically around 32 millimeters of mercury (mm Hg). Sustained pressure above this threshold impedes blood flow, leading to tissue ischemia, where cells are deprived of oxygen and nutrients. If this lack of blood flow continues, cellular death and subsequent skin breakdown can occur.
Pressure injuries most often develop over bony prominences, where there is minimal fat or muscle to cushion the weight against the mattress. Areas at highest risk when a patient is supine include the sacrum, heels, elbows, and the back of the head. When a patient is positioned on their side, the hips, ankles, and shoulders become vulnerable points. The consistent turning routine temporarily relieves the load on these high-risk sites, allowing blood flow to restore and tissue perfusion to normalize.
The risk of injury is compounded by factors like friction, which is the rubbing of skin against a surface, and shear, which involves parallel forces that stretch and distort tissue layers. Shear force often occurs when a patient slides down in an inclined bed, pulling deeper tissue layers away from the skin near the sacrum. Maintaining a regular turning schedule minimizes the duration of these damaging forces on any specific area. This preventative approach is more effective than treating a pressure injury after it has formed.
Adjusting the Repositioning Schedule
While the two-hour interval is a standard guideline, the optimal turning frequency is highly individualized and must be adjusted based on the patient’s specific risk factors. A comprehensive patient risk assessment, often utilizing tools like the Braden Scale, helps care providers determine the patient’s susceptibility to skin breakdown. Patients categorized as high-risk, perhaps due to poor circulation, severe malnutrition, or advanced age, may require repositioning every hour to ensure adequate tissue perfusion.
Conversely, specialized pressure-redistributing equipment can sometimes allow for a longer interval between manual turns. Alternating pressure mattresses or low-air-loss beds work by continuously changing the pressure points on the patient’s body. These surfaces help to mechanically offload pressure, but they do not eliminate the need for manual repositioning and regular skin checks. The decision to extend the turning schedule beyond two hours must be made by a healthcare professional considering the patient’s skin condition and the capabilities of the support surface.
Individual circumstances, such as pain management or the presence of existing wounds, also influence the turning schedule. Repositioning should not cause undue distress, and the timing may be adjusted to coincide with medication administration to improve comfort during the movement. The goal is to find a frequency that balances pressure relief with the patient’s need for uninterrupted rest and comfort.
Safe Turning and Positioning Techniques
Repositioning must be performed with proper technique to avoid the damaging forces of shear and friction. Caregivers should utilize lift sheets or draw sheets, placed beneath the patient, to lift and move them rather than dragging them across the bedding. This technique ensures that the delicate top layers of the skin are not pulled or stretched against the mattress surface, which contributes significantly to skin injury.
A recommended position for lateral turning is the 30-degree side-lying incline. This position involves tilting the patient slightly to one side, using pillows or wedges to maintain the angle. The 30-degree tilt allows the body’s weight to rest on muscle mass and fleshy areas rather than directly on the vulnerable bony prominence of the hip or sacrum. This angling provides effective pressure relief while maintaining stability.
Supportive devices like pillows and foam wedges are important tools for maintaining proper body alignment after the turn is complete. A pillow should be placed between the patient’s knees and ankles to prevent skin-to-skin contact and keep the hips aligned. When the patient is supine, the heels should be suspended or “floated” off the mattress using specialized devices or a pillow placed under the lower legs, as the heels are a common site for injury. Communicating the planned movement to the patient is necessary to ensure cooperation and reduce anxiety.