Ask the Treatment Expert about ... repositioning and mobilization

Rosalyn Jordan, RN, BSN, MSc, CWOCN, WCC
Rosalyn Jordan, RN, BSN, MSc, CWOCN, WCC

How can repositioning and mobilization be most effective in preventing pressure injuries in this day and age? 

One of the most important interventions against pressure injury development is repositioning and mobilization of at-risk residents. Without repositioning and mobilization, skin breaks down quickly. 

Here are 10 recommendations from the National Pressure Ulcer Advisory Panel on positioning:

1. All residents at risk for pressure injury should be turned and repositioned. If this is contraindicated due to the resident's medical condition or treatments, document these reasons and adjust the plan of care.

2. The turning frequency should be determined based on the support surface ordered by the physician, the resident's skin tolerance, and the resident's preference.

3. The length of time between turns may be increased in order to promote an uninterrupted sleep pattern.

4. Use a 30-degree side-lying position and a hand check to determine that the sacrum is not in contact with the mattress.

5. Do not position the resident on areas with existing pressure injury.

6. Elevate heels so they do not touch the mattress or bed frame.

7. When choosing a support surface, consider exposure to shear and moisture, perfusion, and the resident's weight and size.

8. The repositioning schedule must be continued if the resident is placed on a support surface.

9. If moisture is an issue, use a breathable incontinence pad to manage the resident's microclimate.

10. If the resident is bed- to chair-bound, use a pressure-redistribution chair cushion.

Skin care, nutrition and education also remain important aspects of ways to prevent pressure injuries.