Quality statement 6: Help with repositioning

Quality statement

People at risk of developing pressure ulcers, who are unable to reposition themselves, are helped to change their position.

Rationale

A lack of mobility and sensation are risk factors for developing pressure ulcers. If a person is unable to reposition themselves, health and social care professionals should help them to change their position, to prevent the development of pressure ulcers. For some people, repositioning equipment may be needed. The frequency of repositioning should be appropriate for the individual 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 who are unable to reposition themselves at the appropriate frequency are helped to do so.

b) Evidence of local arrangements to ensure that repositioning equipment is available to help with repositioning people who are unable to reposition themselves.

Data source: Local data collection.

Process

a) Proportion of adults at risk of developing pressure ulcers and needing help to change their position who have a plan for repositioning every 6 hours.

Numerator – the number in the denominator who have a plan for repositioning every 6 hours.

Denominator – the number of adults at risk, but not high risk, of developing pressure ulcers who need help to change their position.

Data source: Local data collection.

b) Proportion of adults at high risk of developing pressure ulcers and needing help to change their position who have a plan for repositioning every 4 hours.

Numerator – the number in the denominator who have a plan for repositioning every 4 hours.

Denominator – the number of adults at high risk of developing pressure ulcers who need help to change their position.

Data source: Local data collection.

c) Proportion of neonates, infants, children and young people at risk or high risk of developing pressure ulcers and needing help to change their position who have a plan for repositioning every 4 hours.

Numerator – the number in the denominator who have a plan for repositioning every 4 hours.

Denominator – the number of neonates, infants, children and young people at risk or high risk of developing pressure ulcers who need help to change their position.

Data source: Local data collection.

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

Service providers (community care, hospitals and care homes with nursing) ensure that training in repositioning techniques and use of repositioning equipment are provided for health and social care practitioners so that they can help to reposition people at risk of pressure ulcers if they are unable to reposition themselves.

Health and social care practitioners ensure that they know how to reposition people safely, and that they help people at risk of developing pressure ulcers with repositioning if they are unable to reposition themselves.

Commissioners (clinical commissioning groups and local authorities) should specify that help to change position is given to people in all settings who are at risk of developing pressure ulcers and are unable to reposition themselves.

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

People at risk of developing pressure ulcers who are unable to reposition themselves are helped to change their position at a frequency that is appropriate for their level of risk, and according to their wishes and needs.

Source guidance

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

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)]

People who need help to change their position

Some people may not be able to reposition themselves and need help to do so. This may be for several reasons, including certain physical or mental health conditions.

Equality and diversity considerations

Help with repositioning needs to be tailored to the individual and takes 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, who may have problems understanding the reasons why they are being repositioned. Help with repositioning should also be age‑appropriate, taking into account the needs of children and young people, and their parents or carers.