From the Guidelines
Repositioning should occur at least every 2 hours for individuals at risk of skin breakdown, as recommended by the American Heart Association 1. For those with higher risk factors or already compromised skin integrity, more frequent repositioning every 1-1.5 hours may be necessary. Bedbound patients should have their position changed completely (side to back to opposite side), while wheelchair users should perform small position shifts every 15-30 minutes and major position changes hourly. Overnight, a specialized pressure-redistributing mattress may allow for extended positioning up to 4 hours if skin assessment permits. The frequency should be individualized based on the person's tissue tolerance, mobility level, medical condition, treatment goals, and skin assessment. Some studies suggest that repositioning at a 30-degree tilt position may be associated with increased nonadherence due to intolerability 1. However, the American College of Physicians recommends repositioning as part of a multicomponent intervention to prevent pressure ulcers, although the optimal frequency is not specified 1. Repositioning works by relieving pressure on bony prominences like the sacrum, heels, and hips, restoring blood flow to compressed tissues, and preventing prolonged oxygen deprivation that leads to tissue death. Consistent repositioning schedules should be documented and maintained around the clock, with skin inspected during each position change to identify early signs of breakdown. It is essential to note that the evidence for repositioning intervals is generally of low to moderate quality, and more research is needed to determine the optimal frequency and approach to repositioning 1.
From the Research
Repositioning Frequency to Avoid Skin Breakdown
- The optimal frequency of turning and repositioning to prevent pressure injuries (PIs) remains unclear, and further investigation is necessary 2.
- Studies have explored different repositioning regimens, including frequency of repositioning, use of repositioning systems, and use of turning teams 3.
- One study found that repositioning every 2-3 hours resulted in a 25% reduction in the odds of pressure ulcer development compared to repositioning every 4-6 hours 3.
- The use of a turning team was also found to reduce pressure ulcer incidence by 51% 3.
- However, the certainty of the evidence was assessed as low, and results should be interpreted with caution 3.
- Clinical guidelines recommend a substantial change in a patient's position according to their health status, but the optimal time interval between position changes has not been established 2.
- Repositioning frequency may depend on the healthcare setting and the patient's health conditions, with intervals ranging from 2-hourly to 6-hourly 2.
Considerations for Repositioning
- Patients' health conditions should be considered when choosing the proper frequency to prevent PIs 2.
- The use of repositioning systems and turning teams may be beneficial in reducing pressure ulcer incidence 3.
- Further research is needed to determine the optimal repositioning frequency and to develop evidence-based guidelines for clinical practice 2, 3.