Repositioning in Bed

Repositioning in bed is one of the most frequent caregiving tasks — and one of the most important for preventing complications. Clients who cannot reposition themselves are at risk for pressure injuries, contractures, and discomfort that proper repositioning prevents.

Section 01

Why Repositioning Matters

Pressure injuries: When tissue is compressed between a bony prominence and a mattress, blood flow is interrupted. Within 1–2 hours, tissue begins to break down. Repositioning every 2 hours is the primary prevention.
Contractures: Prolonged immobility in one position allows muscles and tendons to shorten. Repositioning maintains joint range of motion.
Respiratory function: Immobile clients in the same position accumulate secretions. Repositioning promotes secretion drainage and lung expansion.
Comfort: Pressure and discomfort from prolonged immobility affects sleep, mood, and cooperation with care.

Section 02

The 2-Hour Repositioning Schedule

⚠ Document every reposition

Repositioning must occur at minimum every 2 hours for clients who cannot reposition themselves. Every reposition should be documented: time, position changed to, and any skin observations. This documentation is a clinical record — not optional.

The positions in rotation: left side → back → right side → back. Some clients require more frequent repositioning based on their risk level — follow the care plan.

Section 03

Safe Repositioning Techniques

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Log rolling (for spinal precautions)

When spinal alignment must be maintained — the body turns as a single unit. Requires two people: one at shoulders, one at hips. Pillows maintain position. Used post-spinal surgery or with suspected spinal injury.

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Pulling up in bed (draw sheet method)

Never pull a client up by their arms. Use a draw sheet (a folded flat sheet under the client's body): two people grasp the sheet on both sides and slide the client upward on the count. Bed flat, client's chin tucked.

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Turning to the side

Cross the client's far ankle over the near ankle. Bend the far knee. Place one hand on the shoulder and one on the hip. Roll toward you smoothly. Place pillows behind the back and between the knees.

Section 04

Skin Assessment During Repositioning

💡 Every reposition is a skin check opportunity

Each time you reposition a client, observe the skin over bony prominences — the areas of highest pressure injury risk:

Sacrum/tailbone (highest risk — bony prominence directly under back when supine)
Heels
Hip bones (greater trochanters) when side-lying
Shoulder blades
Back of head

What to report: redness that does not blanch when pressed, broken skin, blistering, or any skin change from the previous reposition. Early identification prevents stage 1 pressure injuries from becoming stage 3 or 4.

Section 05

Module 2 Complete

✓ Module 2: Transfers and Repositioning complete

You now know the principles behind every transfer, the step-by-step technique for bed-to-chair, toileting, car, and repositioning — with the knowledge to adapt to new transfer situations using these foundational principles. Module 3 addresses ambulation assistance — supporting clients as they walk.