Step-by-Step Guide to Preventing Pressure Ulcers – Part 1
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Key message: Scientifically scheduled repositioning is the most effective way to prevent pressure ulcers.
Prevention is the single best intervention. In most cases, pressure ulcers can be avoided through attentive care by nurses, caregivers, and family members. The cornerstone of prevention is regular repositioning – changing the patient’s posture frequently to relieve sustained pressure.
Why correct positioning matters
Repositioning reduces both the duration and the intensity of pressure on vulnerable body areas. To achieve this:
1. Encourage the individual to change their own position whenever possible.
2. Avoid placing any weight on bony prominences that show non blanchable redness.
3. Keep the head of the bed as flat as clinically tolerated.
4. Use a 30° lateral tilt when positioning the patient on their side¹.
5. ① National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. (2014) Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline. Emily Haesler (Ed.). Cambridge Media: Osborne Park, Western Australia.
How often should repositioning occur?
The frequency of repositioning must be individualised, taking into account:
l tissue tolerance,
l the patient’s activity and mobility level,
l overall medical condition and treatment goals,
l skin condition, and comfort.
For patients who cannot move themselves, more frequent changes are essential. As a general rule:
Bedridden patients should be repositioned at least every 1–2 hours.
Wheelchair users should shift their position at least every hour – and if possible, they should be encouraged to make small adjustments every 15 minutes on their own.
Caregivers should inspect the skin daily for early signs of redness or discolouration. Any persistent redness over a pressure area is a warning signal – it means immediate repositioning is needed and that the area must be kept off any surface.
Techniques for repositioning
1. Assess whether the chosen new position effectively relieves or redistributes pressure.
2. Avoid placing weight directly on any area with non blanchable erythema (early stage of pressure damage) or on an existing ulcer – this would worsen the injury or delay healing.
3. In most cases, use simple aids such as draw sheets or proper support surfaces (see product recommendations below). Never drag or slide the patient across the bed.
4. For patients who need full assistance, use a mechanical lifting device (e.g., a sling hoist) to transfer them to a wheelchair or chair, and remove the sling immediately after transfer.
5. Ensure the patient is not placed directly on medical tubing, drainage devices, or other foreign objects that could create localised pressure points.
6. Different positions require specific techniques. Below we detail best practices for each common posture.
Prone position (lying face down)
Use a pressure redistributing cushion to pad the face and all pressure points.
The face is at high risk for ulcers in this position – check it thoroughly with every turn.
At each repositioning, assess all at risk areas: chest, knees, toes, penis, clavicles, iliac crests, and pubic symphysis.
Supine position (lying face up)
Place soft pillows under the legs, extending from thighs to ankles, to keep heels free from pressure (i.e., suspend the heels).
Use heel relief boots or U shaped pads under the ankles to offload the heels.
Keep the knees slightly bent and ankles in a neutral position to prevent foot drop; a soft roll at the foot of the bed can help.
Support the scapulae and upper arms with pillows, positioning the shoulders slightly abducted, elbows extended, and wrists dorsiflexed.
Lateral (side lying) position
Bend the upper knee and move the whole leg and body together.
Place a wedge shaped pillow behind the back, providing support from shoulder to hip.
Put a pillow between the legs, extending from knees to ankles, to k eep the heels off the bed and align the hips.
Semi recumbent (head elevated) position
When raising the head, first elevate the bed frame by about 15°, then raise the head section.
Support the affected shoulder and upper arm with a pillow.
Place a firm pillow transversely under the thighs to prevent the patient from sliding down, while keeping both knees slightly flexed.
Finally, ensure that shear forces on the shoulders and sacrum are minimised.
Sitting position
Aim for a stable sitting posture that allows full mobility.
The seat should have adequate tilt to prevent forward sliding. Adjust footrests and armrests to achieve proper pressure distribution.
Feet must be well supported – either flat on the floor or on footrests.
If the feet cannot reach the floor, adjust the footrest height so that the thighs are slightly below horizontal, which tilts the pelvis forward.
For patients with short legs, avoid elevated footrests; if used, they can pull the pelvis into a posterior tilt, increasing pressure on the coccyx and sacrum.
Limit continuous sitting time to no more than 60 minutes at a stretch.
Sitting for patients who already have an ulcer
Minimise sitting time as much as possible, and consult a seating rehabilitation specialist.
Consider prescribing periods of bed rest to promote healing of ischial or sacral ulcers.
If sitting is unavoidable (for sacral/coccygeal or ischial ulcers), limit sessions to 3 times per day, maximum 60 minutes each, and seek expert advice on appropriate seating surfaces and positioning techniques.
Patients with ischial ulcers should avoid fully upright sitting.
If the ulcer worsens or fails to improve, reassess the sitting schedule, the seating surface, and the patient’s posture.
Putting it all together
Pressure reduction is the key to prevention, and the most practical method is regular, individualised repositioning using correct techniques and appropriate assistive devices. An electric pressure relieving bed (such as the ones featured in our product section) is specifically designed for long term bedridden patients. It offers programmable position changes and timed alternating pressure modes, which not only meet the frequency needs of repositioning but also significantly lower the risk of developing pressure ulcers.
Final reminder
Prevention is always better than cure. Pressure ulcers are preventable and treatable – with the right support surfaces and careful care, their incidence can be dramatically reduced.
If you notice any suspicious skin changes, do not hesitate to seek medical advice. A healthcare professional can design a personalised prevention and treatment plan tailored to your or your loved one’s needs.
Coming up in Part 2 – More advanced prevention strategies and practical tips.
