Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Positioning and Support Surfaces – A Checklist

When considering the impact of pressure, shear and friction on the client, review the following while planning care.

Don’t forget to:

  • Avoid positioning patients on a pressure ulcer. (Level of Evidence = IV)
  • Avoid positioning immobile patients directly on their trochanters and use devices such as pillows and foam wedges to position a pressure ulcer off the support surface. (Level of Evidence = IV)
  • Avoid positioning immobile patients with pressure directly on their heels and use devices such as pillows and foam wedges to position a pressure ulcer off the support surface, while avoiding pressure on the Achilles’ tendon. (Level of Evidence = IV)
  • Use positioning devices such as pillows or foam to prevent direct contact between bony prominence (such as knees or ankles). (Level of Evidence = IV)
  • Avoid using donut-type devices. (Level of Evidence = IV)
  • Maintain the head of the bed at the lowest degree of elevation consistent with medical conditions and other restrictions. Limit the amount of time the head of the bed is elevated. (Level of Evidence = IV)
  • Establish a written repositioning schedule. (Level of Evidence = IV)
  • Individuals who are able should be taught to shift their weight every 15 minutes (e.g., by leaning forward). Reposition the sitting individual so the points under pressure are shifted at least every hour. Consider the use of a wheelchair with a tilt mechanism. (Level of Evidence = IV)