Pressure Injury Survey Guide

Types of Pressure Injury Prevention Interventions

Routine Repositioning

The purpose of turning/repositioning patients is to reduce the duration and magnitude of tissue pressure. Care should be taken during repositioning to minimize shear.

Patients in bed

  • Studies suggests that the turning/repositioning frequency should be influenced by the individual and the support surface in use.1
    • Many clinicians start by turning immobile patients every 2 hours while in bed as this is a common practice for patients unable to turn/reposition themselves.
    • Repositioning frequency can be tailored based on the individual’s tissue tolerance, level of activity and mobility, general medical condition, overall treatment goals, skin condition and comfort.1
    • Patients who are at higher risk will likely need to be turned/repositioned more frequently than every 2 hours.
    • Specialized support surfaces may reduce the frequency of turning/repositioning.2-4 Patients should be repositioned routinely regardless of the support surface used.
  • The patient’s skin must be closely monitored to determine tissue response to the turning/repositioning schedule. If possible, avoid turning patients onto reddened skin.1
  • Slow, gradual turns may be needed to stabilize patient hemodynamic and oxygen status while turning.1, 5
  • Premature neonates should be monitored for apnea, bradycardia/tachycardia, and oxygen recovery time to determine their response to the turning schedule.
  • Document the time the patient was turned/repositioned and the position adopted.

  1. National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel, & Pan Pacific Pressure Injury Alliance. (2014). Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline (Emily Haesler Ed.). Osborne Park, Western Australia: Cambridge Media.
  2. Bergstrom, N., Horn, S. D., Rapp, M. P., Stern, A., Barrett, R., & Watkiss, M. (2013). Turning for Ulcer ReductioN: A Multisite Randomized Clinical Trial in Nursing Homes. J Am Geriatr Soc,61(10), 1705-1713. doi:10.1111/jgs.12440
  3. Defloor, T., De Bacquer, D., & Grypdonck, M. H. F. (2005). The effect of various combinations of turning and pressure reducing devices on the incidence of pressure ulcers. Int J Nurs Stud, 42(1), 37-46.
  4. Gillespie, B. M., Chaboyer, W. P., McInnes, E., Kent, B., Whitty, J. A., & Thalib, L. (2014). Repositioning for pressure ulcer prevention in adults. Cochrane Database Syst Rev, 4, CD009958. doi:10.1002/14651858.CD009958.pub2
  5. Brindle, C. T., Malhotra, R., O'Rourke, S., Currie, L., Chadwik, D., Falls, P., . . . Creehan, S. (2013). Turning and Repositioning the Critically Ill Patient With Hemodynamic Instability: A Literature Review and Consensus Recommendations. J Wound Ostomy Continence Nurs, 40(3), 254-267. doi:10.1097/WON.0b013e318290448f