Quality statement 5: Advice on repositioning

Quality statement

People at risk of developing pressure ulcers receive advice on the benefits and frequency of repositioning.

Rationale

Repositioning, where the person moves into a different position in a chair or bed, aims to reduce or stop pressure on the area at risk. To improve patient experience, health and social care professionals should advise people at risk of developing pressure ulcers (or their carers, as appropriate) about the importance of frequent repositioning, and that it may help to prevent pressure ulcers. The frequency of repositioning advised should be appropriate for the individual person and their wishes and needs. For safety reasons, repositioning is recommended at least every 6 hours for adults at risk, and every 4 hours for adults at high risk. For children and young people at risk, repositioning is recommended at least every 4 hours, and more frequently for those at high risk.

Quality measures

Structure

a) Evidence of local arrangements to ensure that people at risk of developing pressure ulcers are given advice on the benefits and frequency of repositioning.

Data source: Local data collection.

Process

a) Proportion of adults newly identified as being at risk of developing pressure ulcers that are given advice to change position at least every 6 hours.

Numerator – the number in the denominator, or their carers, who receive advice to change position at least every 6 hours.

Denominator – the number of adults newly identified as being at risk, but not at high risk, of developing pressure ulcers.

Data source: Local data collection.

b) Proportion of adults newly identified as being at high risk of developing pressure ulcers that are given advice to reposition at least every 4 hours.

Numerator – the number in the denominator, or their carers, who receive advice to change position at least every 4 hours.

Denominator – the number of adults newly identified as being at high risk of developing pressure ulcers.

Data source: Local data collection.

c) Proportion of children and young people newly identified as being at risk or high risk of developing pressure ulcers that are given advice to change position at least every 4 hours.

Numerator – the number in the denominator, or their carers, who receive advice to change position at least every 4 hours.

Denominator – the number of children and young people newly identified as being at risk or high risk of developing pressure ulcers.

Data source: Local data collection.

What the quality statement means for service providers, health and social care practitioners, and commissioners

Service providers (primary care, community care, hospitals and care homes with nursing) ensure that people who are at risk of developing pressure ulcers are given advice on the benefits of repositioning and frequency of repositioning according to their level of risk.

Health and social care practitioners ensure that they give people at risk of developing pressure ulcers advice about the benefits of repositioning and the frequency of repositioning according to their level of risk.

Commissioners (NHS England area teams, clinical commissioning groups and local authorities) should specify that people who are at risk of developing pressure ulcers are given advice on the benefits of repositioning and frequency of repositioning according to their level of risk.

What the quality statement means for patients, service users and carers

People who are at risk of developing pressure ulcers should receive advice about changing their position regularly, how changing position can help reduce the risk of developing a pressure ulcer, and how frequently they should change position (according to their individual risk of developing a pressure ulcer).

Source guidance

  • Pressure ulcers (2014) NICE guideline CG179, recommendations 1.1.8 (key priority for implementation), 1.1.9, 1.2.5, 1.2.6, 1.2.8 and 1.2.11

Definitions of terms used in this quality statement

Risk of developing pressure ulcers

People considered to be at risk of developing a pressure ulcer are those who, after assessment using clinical judgement and/or a validated risk assessment tool, are considered to be at risk of developing a pressure ulcer. Risk factors include:

  • significantly limited mobility (for example, people with a spinal cord injury)

  • significant loss of sensation

  • a previous or current pressure ulcer

  • malnutrition

  • the inability to reposition themselves

  • significant cognitive impairment.

[Pressure ulcers (NICE guideline CG179) recommendations 1.1.2 and 1.2.1]

High risk of developing pressure ulcers

People considered to be at high risk of developing a pressure ulcer will usually have multiple risk factors identified during risk assessment with or without a validated risk assessment tool. Adults with a history of pressure ulcers or a current pressure ulcer are also considered to be at high risk.

[Pressure ulcers (NICE guideline CG179)]

Equality and diversity considerations

The advice on repositioning needs to be appropriate to the individual and take into account their needs and those of their carers. This is especially the case for people with degenerative conditions, impaired mobility, neurological impairment, sensory impairment, and cognitive and behavioural difficulties. The advice should also be age‑appropriate, taking into account the needs of children and young people, and their parents or carers.