4 Repositioning and Pressure Offloading

Why repositioning matters

Repositioning reduces how long and how strongly pressure acts on vulnerable tissue. The aim is to redistribute pressure and fully offload vulnerable areas, not simply to follow a clock. A Pressure-redistribution surface can help, but it does not replace repositioning.

Choosing repositioning intervals

A Repositioning interval should be based on a comprehensive assessment rather than the same fixed schedule for everyone. Consider the person’s mobility and ability to move independently, skin and tissue response, clinical condition, comfort, sleep, goals of care, and support surface.

Two- or three-hour intervals may be considered for many people at risk who are using an appropriate pressure-redistribution surface, but the interval should be adjusted to the person’s assessment and response. Do not assume that everyone needs an exact two-hour schedule, and do not routinely extend intervals to four, five, or six hours. A surface alone does not remove the need to reposition.

Monitoring skin and tissue

Check pressure points during repositioning and after relevant changes in the person’s condition or care. Signs that call for prompt assessment include persistent redness or other color change, pain or tenderness, localized swelling, and a change in skin temperature. Color changes may be harder to see on darker skin tones, so include touch and the person’s report of symptoms in the assessment.

These changes may indicate that the current plan is not working. Reassess the person and consider more frequent repositioning or Pressure offloading. Avoid massaging areas of persistent redness; have them assessed instead.

Putting the plan into practice

An Individualized repositioning plan should specify how and when assistance will be provided for weight shifts or position changes. It should also address whether the chair and cushion provide suitable pressure redistribution and postural support, how pressure points will be checked, how changes will be addressed, and the person’s ability, comfort, and goals. Do not copy another person’s schedule unchanged.

For a person who is bedbound and has persistent redness over a bony area, reposition them to take pressure off the area and avoid positioning directly on it while it is assessed. Use appropriate positioning aids, such as pillows, to redistribute pressure, and check the person’s skin and comfort during repositioning. Document the response and promptly notify the responsible clinician about persistent changes. Review the interval and technique, increasing repositioning or offloading if assessment indicates it is needed. Determine the specific plan with the person and care team.

When supporting the heels of a person lying in bed, place support under the calves so the heels are lifted clear of the mattress. Check that the legs and feet are supported comfortably and that the support does not create new pressure points. Check the heels and feet when positioning pillows under the calves.

Reassessing the plan

Reassess the plan because mobility, clinical condition, comfort, skin response, goals, and equipment can change. Persistent skin or tissue changes may mean the current plan needs prompt review. Adjust the plan when assessment or a change in condition or care shows that the existing approach is no longer suitable.