Repositioning patients in ICU: A collaborative approach

Abstract

Intensive care patients are repositioned every 2–3 h to assist with physical and psychological comfort and to minimise potential complications of immobility. Provision of this care requires significant nursing and orderly resources. This project was designed to explore the time required to reposition patients and to explore factors that impede repositioning.

A time and motion design was used to measure the time required for each of the components of repositioning. The time spent at each bed was referred to as bed time (BT); this included the time taken to turn the individual patient (TT) as well as preparation time (PT). Factors that delayed or prevented repositioning were recorded.

Three hundred and eighty-nine patients were repositioned with 890 procedures undertaken during repositioning. Patients were repositioned for pressure area care (n = 309; 35%), repositioning (n = 201; 23%), hygiene (n = 100; 11%), linen change (n = 88; 10%), and bowel care (n = 60; 7%). The average times were: BT 5.14 minutes (S.D. = 2.9), TT 3.54 min (S.D. = 2.5), PT 1.12 min (S.D. = 0.84).

Univariate analysis of impediments affecting the TT included nurses (β 1.1; p < 0.001) and equipment (β 1.9; p < 0.001) not prepared. For each impediment observed, the repositioning round increased by 0.85 min (p < 0.001).

Repositioning of patients is undertaken for various reasons, with multiple activities undertaken simultaneously at the time of repositioning. The time required to complete a patient repositioning round is directly affected by the preparedness of nursing staff. Strategies to improve nurse preparedness should be implemented to optimise the time and resources available for patient repositioning.