Registered Nurses' Association of Ontario

Re-Positioning Schedule

  • A re-positioning schedule of at least every two hours should be promptly implemented when using a standardized mattress, emergency stretcher or operating table surface
  • When using a pressure management surface (re-distribution mattress or cushion) use a re-positioning schedule of at least every four hours or as required by the patient’s condition
  • When choosing a therapeutic support surface, special attention needs to be given to the issue of entrapment
  • Seven Zones of Entrapment
    1. Within the rail.
    2. Under the rail (between the rail supports or next to a single rail support).
    3. Between the rail and the mattress.
    4. Under the rail at the ends of the rail.
    5. Between split bed rails.
    6. Between the end of the rail and the side edge of the headboard or footboard.
    7. Between the head board or footboard and the mattress end.
  • To minimize the risk of entrapment consider:
    • Selecting a surface that has a transfer boarder as it may be less likely to compress as the client approaches the side of the surface;
    • Evaluating the use of bed rails – the client may be at less risk when these are not in place;
    • Implementing other devices, such as positioning wedges or a mattress cover with built in bolsters; and/or
    • Consulting with an occupational or physical therapist skilled in this area to complete a client assessment and make specific recommendations.
Clinical Management
Risk Assessment and Prevention of Pressure Ulcers
Point of Care Resources