Safe Repositioning Patients in Healthcare: Techniques, Tools & Best Practice
Repositioning in Nursing: Preventing Pressure Ulcers
Patient repositioning (or repositioning patient in healthcare) means moving someone in bed or in a chair to a new position. This helps take pressure off areas like the back, heels, and hips, which can get sore if someone stays in one spot too long. To help prevent pressure sores, people should be moved at least every 6 hours, or every 4 hours if they are at high risk.
Repositioning is a type of care where a nurse or carer changes a patient’s position in bed. It helps stop pressure sores and keeps the skin healthy by spreading body weight and improving blood flow. Patients are usually moved every two hours.
This is very important for people who can’t move by themselves or stay in one position for too long. Carers can turn patients from their back to their side or stomach, making sure their arms and legs are not pressing against each other.
In hospitals or care homes, repositioning is done by a team – including nurses, physios, and paramedics – to give the best care. Special tools like hoists and slide sheets can be used to make repositioning safer. Staff need training to use this equipment properly.
Repositioning often helps skin stay healthy and lowers the chance of getting sores. Some people need to be moved more often than others, and carers decide what works best based on the person’s needs.
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Key Tools for Moving and Repositioning Patients
There are many helpful tools that carers and nurses can use to move and reposition patients safely. These tools help protect the patient’s skin and also make the job easier for staff.
Slide Sheets and Transfer Sheets
Slippery sheets placed under the patient to help slide and turn them more easily. They reduce rubbing on the skin and prevent injuries. Some are disposable, while others are washable and reusable.
Turning and Repositioning Systems
Special sheets with handles or built‑in supports that help carers move the patient while keeping their body in the correct position.
Ceiling Track Hoists
Lifting machines fixed to the ceiling. They allow safe movement without manual lifting, ideal for patients who cannot move independently.
Mobile Floor Lifts
Portable hoists that can be moved between rooms. They lift patients using a sling when a ceiling hoist is not available.
Electric Profiling Beds
Special hospital beds that adjust to support safe movement and care. Features may include:
- Raising the head or feet
- Tilting the whole bed
- Built‑in weighing scales
Pressure Redistributing Mattresses
Mattresses designed to spread body weight and protect the skin. Types include:
- Foam mattresses
- Alternating‑air pressure mattresses
- Airflow mattresses
- Hybrid systems combining different technologies
Positioning Wedges and Cushions
Soft supports used to keep the patient in a safe and comfortable position. These include:
- Turning wedges
- Heel‑lift cushions
- Head, neck, and knee supports
- Special pillows to separate body parts
Air‑Assisted Transfer Devices
Inflatable mats that use air to help slide the patient. Particularly useful for larger patients.
Transfer Boards
Hard or semi‑rigid boards that help move a patient from one surface to another, such as from a bed to a wheelchair.
Handling Belts and Walking Belts
Belts with handles placed around the patient’s waist to provide support when standing, walking, or repositioning in a chair.
Turn Sheets with Handles
Strong sheets with built‑in handles that help carers turn or reposition the patient safely.
Using these tools correctly helps protect the patient and prevents injuries to carers. They make repositioning safer, more comfortable, and more efficient for everyone involved.
What Repositioning a Patient Means
Repositioning a patient means changing how they are sitting or lying down. This can be in a bed, chair, or wheelchair. It is an important skill for nurses and carers, especially when the person cannot move by themselves.
This helps take pressure off certain parts of the body. It is very important to prevent pressure sores, improve blood flow, and make the person feel more comfortable. It also helps keep people healthy, especially those who cannot move much on their own.
Repositioning should be done often to stop problems like pressure ulcers or bedsores. The new positions can include lying on the back, lying on the side, sitting up in bed, sitting in a chair, or even walking if they are able to.
Care staff can move a person by hand or use special equipment like hoists or pressure-relieving beds. How often someone should be moved depends on their health. People in bed might need moving every 2 hours. People in wheelchairs may need to change position every 15 minutes to 1 hour.
âś…Important Training: Safe Patient Repositioning Training for Caregivers
What Does Repositioning a Patient Mean?
Repositioning means helping a patient change their body position to stay safe, comfortable, and protected from pressure damage. It can include:
- Turning a patient from one side to the other
- Moving them from their back to their side or the other way around
- Helping them sit up if they were lying down
- Changing their position in a chair or wheelchair
- Using pillows to lift or support parts of their body
- Following a turning plan, such as repositioning every 2 hours
- Making small adjustments to spread pressure evenly
How Is Repositioning a Patient Done?
Repositioning depends on several factors, including:
- The person’s size, health, and mobility level
- Whether they can help move or not
- What equipment is available (such as slide sheets or hoists)
- How many staff members are assisting
- Any health conditions that affect movement
Steps usually include:
- Explaining to the person what you are going to do
- Moving safely to avoid injury to staff or the patient
- Using equipment if needed
- Ensuring the body is aligned correctly
- Using pillows or cushions for support
- Recording the new position and the time it was completed
Image Credit: Science Direct: Prevention of Pressure Ulcer Among People With Spinal Cord Injury.
Types of Repositioning and When to Use Them
Repositioning helps prevent pressure sores and keeps the body working well. Different positions are used for different reasons. Here are the common ones and when to use them:
Common Positions
- Supine – lying flat on the back
- Side‑lying (lateral) – lying on one side
- Prone – lying on the stomach (used in special cases)
- Semi‑Fowler’s – head raised 30–45°
- High Fowler’s – sitting up 60–90°
- 30‑degree tilt – slightly turned to reduce pressure
People in bed are usually repositioned every 2–4 hours. Those in chairs should be repositioned every hour. The exact timing depends on the person’s needs and care plan.
Supine Position (Lying on Back)
When to use:
- To check airways or carry out medical assessments
- For care or treatment on the front of the body
- When eating (head must be raised)
- For certain back conditions
Things to know:
- Pressure on back, heels, and head
- Risk of choking if head not raised
- Not suitable for long periods if mobility is limited
30° Lateral Tilt Position
When to use:
- To reduce pressure on the back
- For people at high risk of pressure sores
- When full side‑lying is uncomfortable
Things to know:
- Use pillows to maintain the tilt
- Protects bony areas like hips
- Often more comfortable than full side‑lying
Lateral Position (Side‑Lying)
When to use:
- To relieve pressure on the back
- For washing or back care
- For lung problems (good lung down)
- To reduce choking risk in unconscious patients
Things to know:
- Use pillows between knees and under arms
- Ensure hips, shoulders, and ears are aligned
Semi‑Fowler’s Position (Head Raised 30–45°)
When to use:
- After meals to help digestion
- For breathing or heart problems
- When taking oral medication
Things to know:
- Improves breathing and reduces choking
- May require knee elevation to prevent sliding
- Less pressure on heels than lying flat
High Fowler’s Position (Head Raised 60–90°)
When to use:
- When eating or drinking
- For breathing difficulties
- To help communication and alertness
Things to know:
- Risk of sliding down the bed
- Use pillows or supports for safety
- Not suitable for long periods without checks
Prone Position (Lying on Tummy)
When to use:
- In ICU for breathing support
- For certain back treatments
- To relieve pressure on the back
Things to know:
- Requires trained staff and teamwork
- Not safe for some people (e.g., pregnancy, facial injuries)
- Needs close monitoring
Chair Position
When to use:
- During the day for normal activities
- For eating, socialising, and better breathing
Things to know:
- Requires more frequent movement (about every hour)
- Use cushions if needed
- Ensure proper sitting posture
Special Techniques
Microshifting
- Small, frequent adjustments
- Good for fragile or sensitive skin
- Used between major repositioning
Bridging and Rolling
- Helps move someone in bed
- Useful for sheet changes or hoist use
Log Rolling
- Used for back or spinal injuries
- Keeps the spine aligned
- Common after certain surgeries
How Often to Reposition
- High‑risk patients (in bed): Every 2 hours
- In chairs: Every hour, with weight shifts every 15 minutes
- Lower risk: Every 2–4 hours depending on skin checks
- Very ill patients: As often as needed based on condition
Each repositioning plan should be individualised based on the patient’s condition, risk factors, comfort, and clinical needs.
Tools and Scales for Patient Repositioning
Healthcare staff use different tools and scales to measure, record, and guide how patients are moved. These help ensure care is consistent and that patients are repositioned at the right times.
Pressure Sore Risk Tools
1. Braden Scale
- Assesses how likely a patient is to develop pressure sores
- Looks at mobility, moisture, activity, nutrition, and friction
- Lower scores mean higher risk and more frequent repositioning
- Scores below 18 indicate increased need for care
2. Waterlow Scale
- Commonly used in the UK
- Assesses mobility, skin condition, and neurological issues
- Higher scores mean higher risk and more frequent repositioning
3. Norton Scale
- One of the earliest pressure risk tools
- Assesses physical condition, mental state, activity, mobility, and incontinence
- Lower scores mean higher risk
Charts and Tracking Tools
4. Turning Clocks
- Clock‑style charts showing repositioning times
- Record when the patient was last moved
- Show the position used and who completed the move
- Include notes on skin condition
5. Repositioning Charts
- Track how often the patient is moved
- Record how long they stay in each position
- Note comfort, pain, or distress
- Record pillows, supports, or equipment used
6. Electronic Monitoring Tools
- Some beds or sensors track how long a patient stays in one position
- Send alerts when it’s time to reposition
- Create reports to support care planning
Movement and Help Levels
7. Functional Independence Measure (FIM)
- Shows how much help a patient needs to move
- Scores range from 1 (full assistance) to 7 (independent)
- Lower scores mean more support is needed for repositioning
8. Barthel Index
- Measures how well a patient performs daily activities
- Includes mobility tasks like bed‑to‑chair transfers and walking
- Helps determine the level of assistance required
Extra Tools for Better Repositioning
9. Pressure Mapping Systems
- High‑tech mats that show pressure points on the body
- Identify areas at risk of skin breakdown
- Help staff adjust the patient’s position effectively
10. Pain and Comfort Scales
- Used to check if the patient is in pain during movement
- May use numbers, faces, or behavioural cues
- Essential for patients who cannot communicate verbally
Why Repositioning is Important in Nursing
Repositioning means helping a patient move into a different position. It is one of the most important things nurses and care workers do. It helps in many ways:
- Prevents Pressure Sores
When a person lies or sits in the same position for too long, pressure builds on certain body parts like the bottom, heels, or shoulders. This can stop blood flow and cause painful skin sores (called pressure ulcers). Moving the person often helps prevent these sores. - Helps with Breathing
Changing positions helps the lungs open up and keeps chest muscles working. If someone stays lying down too long, fluid can collect in the lungs, which may cause chest infections. Repositioning helps the person breathe better and keeps their lungs healthy. - Keeps Joints Moving
If a person doesn’t move for a long time, their joints and muscles can become stiff. Repositioning helps keep their arms, legs, and back flexible. This prevents tightness and helps with movement later on. - Improves Blood Flow
Moving helps the blood go around the body properly. If someone stays still for too long, they might get blood clots in their legs. Repositioning helps stop this from happening. - Makes People Feel Better
Being in the same spot can be uncomfortable or painful. Helping someone change position gives them relief and helps them sleep better. It also shows respect for their comfort and dignity. - Helps with Digestion and Toileting
Some positions help the body digest food and pass waste properly. Moving around helps stop problems like constipation, which are common in people who stay in bed a lot. - Lowers Infection Risk
If the skin breaks down from pressure, it can let germs in and cause infection. Repositioning helps keep the skin healthy and lowers the risk of infections. - Keeps the Mind Active
Moving into new positions gives the brain different feelings and views. This helps the person stay more alert, especially if they are in bed for a long time.
Repositioning is a simple but essential part of care. Each person has different needs, so staff should assess individuals regularly. Frequent repositioning helps prevent complications and keeps patients safe and comfortable. Training in safe repositioning builds the skills and confidence needed to do this effectively.
Best Practices for Manual Patient Repositioning.
1. Make a Repositioning Plan for Each Patient
Every person is different. Check their skin, comfort, and how well they can move. Most at-risk adults should be moved every 2 to 4 hours, but some may need more or less. Use your judgement and follow care plans.
2. Choose the Best Positions
The 30° side-lying position is better than lying flat on the back or fully on the side (believed to be). It puts less pressure on bony parts like hips and back. Don’t leave patients sitting fully upright for too long, as this can cause pressure and sliding.
3. Use Safe Moving Techniques
Never drag patients across the bed—it can hurt their skin. Use tools like slide sheets, hoists, pillows, or wedges to move them safely. Follow your workplace rules and check instructions on how to use each item.
4. Check Skin and Comfort
Look at the skin each time you move the patient. Check for red marks or sore spots. Make sure there are no wires, tubes, or objects under them, and that they’re lying in a comfy and safe position.
5. Talk to the Patient
If the patient can speak or understand, ask what’s comfortable for them. Let them know what you are doing. If they are in pain, they may need pain relief before moving. Talking helps them feel calm and cared for.
6. Write It Down (Document)
Keep a note of when the patient was moved, the position used, and how their skin looked. This helps other staff and shows early signs if there’s a problem.
Top Dangers of Repositioning Patients.
1. Patient Falls
If a patient is not moved safely or left unsupported, they might fall. Falls can cause broken bones or head injuries, especially in older or weak people.
2. Skin Damage from Dragging
Pulling a patient across the bed without lifting can hurt their skin. This can lead to cuts, bruises, or pressure sores.
3. Injuries to Staff
Nurses and carers can hurt their backs, shoulders, or necks if they move patients the wrong way. This can cause serious problems and stop them from working.
4. Tubes or Wires Coming Loose
If a patient has tubes (like drips or feeding tubes), moving them carelessly can pull these out, which can be painful or dangerous.
5. Pain for the Patient
Some patients may feel pain when moved, especially if they have sore joints, wounds, or had surgery. It’s important to move them gently.
6. Breathing Problems
Some positions can make it hard for a patient to breathe, especially if they already have breathing problems.
7. Feeling Dizzy or Faint
If a patient is moved too quickly, they might feel dizzy or even faint. This can happen more with very ill patients or those on strong medicine.
8. Joints Popping Out
If you move someone with weak joints the wrong way, their joints can pop out of place (dislocate), especially if they have had joint problems before.
9. Hurting the Spine
Some patients need to keep their back very straight. Moving them the wrong way can hurt their spine, especially after surgery or an injury.
10. Pressure in the Wrong Places
If pillows or supports are not put in the right place, the pressure can move to another area and cause new pressure sores.
To stay safe: staff should be trained, use the right equipment, and work together to move patients the right way. This helps keep both patients and carers safe.
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