How often should I turn and reposition residents to prevent pressure ulcer development?

Turning, repositioning and mobilization are important interventions to assist in pressure ulcer prevention. Many clinicians continue to maintain an every two-hour turning intervention that has been indicated for years. 

Pressure and/or shear on any bony prominence for a prolonged time period can result in soft tissue distortion and may reduce blood flow and tissue oxygenation. Small capillaries in that area of soft tissue are distorted, twisted, bent or totally occluded due to the pressure or shear exerted on the area. Tissue destruction will occur without adequate oxygenation and perfusion in the tissue resulting in pressure ulcer formation.

Turning, repositioning and/or mobilization will remove pressure and allow for tissue reperfusion.

The standard of care for many years was a turning and repositioning schedule every two hours. The best information available now indicates that turning and repositioning should be based on the individual’s specific condition such as the resident’s individual general medical condition, pressure ulcer risk status, skin assessment, activity level or mobility ability, and overall tissue tolerance. 

The resident’s comfort or pain level with turning, repositioning and mobility should be considered.

An individualized schedule that meets the resident’s needs should be determined and initiated. This should be documented in the medical record. Include special equipment if necessary.

An established and implemented individualized movement and mobility program based on the resident’s individual needs will help prevent pressure ulcer development. 

Staff education is always an element that must be included in the treatment plan.