Editor's note: This tip was originally published in July 2009. It has been updated with the latest clinical information and online resources.
As you read this article, focus on how many times you move your body. Think of how many times you move around during a meeting or while sitting through a movie.
Now imagine what it would feel like if you could not move. Can you feel the discomfort and pressure?
Relieving pressure is the most important thing we can do to prevent pressure ulcers. Caregivers can do a lot to help reposition, even with basic supplies like pillows.
Some useful ways of relieving pressure:
- Reposition bed-bound persons at least every 2 hours, chair-bound persons every hour
- When possible, teach chair-bound persons to shift weight every 15 minutes
- Use a written, individualized repositioning schedule. Residents who are bed-bound may need repositioning more than once every hours. Some may need to be turned from left to right, avoiding the back.
- Use pressure-reducing mattresses or chair cushions. See the Managing Tissue Loads tool for more information.
- Use pillows or wedges to keep knees and ankles from direct contact with each other
- Use a pillow under the calf to relieve pressure on the heel
- Elevate the head of the bed as little (max 30 degree angle) and for as short a time as possible
Share the tips above with staff consistently, at stand-up meetings, during changes in shift rounds, during in-services or when residents' conditions change. Include residents and their family members in planning their individualized repositioning schedules, so they are active partners, aware of the prevention strategies used in your home.
For more information on relieving pressure, visit www.nhqualitycampaign.org, www.moaha.org, and www.mohealthcare.com. On the Primaris Nursing Home Pressure Ulcer Resource page, you can obtain resources such as:
- “Take the Weight”, a flyer to log interactions residents need during transfers and other Activities of Daily Living(ADLs).
- Primaris’ Interactive Pressure-Ulcer Prevention Training video for nurses(order here)
- Shower Assessment form, for looking for signs of pressure ulcer formations
- Tracking Posters with Stickers for logging pressure ulcer cases
- Encourage someone on staff to provide an in-service, demonstrating the tips above. This could be the treatment nurse, or a Certified Nursing Assistant(CNA) passionate about pressure-ulcer prevention.
- Round consistently, ensuring pressure ulcer prevention is occurring. Acknowledge effective actions you see and praise those responsible. Reeducate when needed.
- Keep extra pillows/cushions easily accessible for all CNAs. Create a system for ordering and replacing these supplies.
- Communicate with staff verbally and in writing about your pressure ulcer reduction strategies. Ask successful staff members to share their ideas for improvement with the team.
- Include pressure ulcer prevention education in your staff orientation and annual education materials.