Pre‐procedure

ActionRationale

1. 1.Show
   Collect all of the equipment listed and place it by the bedside. If available, use the linen tray at the end of the bed, or a clean chair beside the bed within comfortable reach. If the patient is in the bed, offer assistance to them to transfer to a chair
   To ensure efficient time use and reduce the need to leave the bedside. E
2. 2.Show
   Carry out hand hygiene and apply personal protective equipment (apron and gloves).
   To protect against the transfer of contaminants on the hands of the healthcare worker causing cross‐contamination. Linen could be contaminated with body fluids (Bloomfield et al. [22], E; NHS England and NHSI [148], C).
3. 3.Show
   Clear the area of any obstacles; be aware of any items of clinical equipment – e.g. call bell cords, drip stand, electrical cords. If necessary, move the bed to gain adequate space to move freely to carry out the procedure.
   To maintain a safe environment (NMC [162], C).
4. 4.Show
   Reposition the bed as required and then check that the bed brakes are on. Adjust the bed to an appropriate height to maintain a comfortable posture during the procedure.
   To prevent the bed moving unexpectedly and to avoid back injury (Davis and Kotowski [48], R).
5. 5.Show
   The linen skip should be positioned and kept near to the bed throughout the procedure.
   To reduce the potential dispersal of micro‐organisms, dust and skin cells from the linen into the environment (Bloomfield et al. [22], E; DH [49], C).

Procedure

1. 6.Show
   Check the bed linen for the presence of any personal articles belonging to the patient. Remove any call bells attached to the linen.
   To ensure that personal belongings are not lost when the soiled linen is disposed. To promote patient comfort. E
2. 7.Show
   Remove and fold unsoiled, reusable linen. Place on the pull‐out tray at the foot end of the bed (if available).
   To ensure reusable linen is stored for reuse. E
3. 8.Show
   Loosen the linen, moving methodically from the head of the bed to the foot end of the bed. Remove pillowcases and place them with the soiled sheets. Place pillows on the pull‐out tray at the foot end. Avoid shaking the soiled linen.
   To avoid stretching across the bed, causing back injury (Davis and Kotowski [48], R).

   To minimize the risk of cross‐infection (Peate and Lane [177], E; Rebeiro et al. [197], E).
4. 9.Show
   Fold the soiled linen into the centre of the bed and secure it into a roll. Avoid putting any soiled linen on the floor or holding it against your uniform. Gather it together and place it directly in a linen skip.
   To prevent the spread of micro‐organisms to the environment via airborne or contact means (Bloomfield et al. [22], E; DH [49], C; Lynn [115], E; Potter et al. [188], E).
5. 10.Show
   If soiled, clean the mattress as per local policy. Check the mattress to ensure integrity of the covering.
   To maintain a clean environment and prevent the spread of micro‐organisms (Fraise and Bradley [70], C; Spencer [217], E).
6. 11.Show
   Remove gloves and dispose of them in an appropriate receptacle. Carry out hand hygiene. Replace gloves if the patient's infection status necessitates.
   To avoid cross‐contamination of clean bed linen from soiled gloves (NHS England and NHSI [148], C).
7. 12.Show
   Make a mitred ‘hospital corner’: stand at the head of the bed. Tuck the top of the sheet under the top (short) end of the mattress. Then move to stand alongside the long side of the mattress. At the head end of the mattress, pick up the edge of the sheet approximately 50 cm from the head of the bed. Lift the sheet to make a triangle‐shaped fold in the sheet. Lay the formed triangle of sheet on the bed, Lift the corner of the mattress and tuck the hanging straight edge of the sheet under the mattress. Lift the triangle fold down over the tucked‐in sheet and tuck it under the mattress. This should form a triangle at the corner of the bed (Action figure 9.3). Note: it is advised that pressure‐relieving mattresses should have their sheets left untucked.

   If working in pairs: work from the head of the bed to the foot end.

   If working alone: make up the linen on one side of the bed before moving to the other side and completing the bed.
   To secure the position of the sheet so that it does not move when the bed is occupied by the patient. E

   To work in the most time‐efficient way. E
8. 13.Show
   Ensure the sheet is pulled tight to ensure a smooth surface under the patient.
   To reduce the discomfort caused by wrinkles in the sheet. To ensure a smooth, comfortable surface for the patient. E
9. 14.Show
   Place the top sheet on the bed and open it out so that the centre crease is running down the middle of the mattress and the top hem is approximately 20–30 cm from the top of the mattress. The foot end of the top sheet can either be folded over to form a horizontal cuff or tucked under with a mitred corner. Leave the sides of the sheet hanging freely.
   Follow local guidance or patient preference. A cuffed top sheet can provide more room for the patient's feet. E
10. 15.Show
    Place the blanket on the bed. Open it out so that the centre seam is in the centre of the mattress and the top seam is approximately 20–30 cm from the top of the mattress.
    To ensure the blanket is placed in the middle of the bed. E
11. 16.Show
    At the head end of the bed, fold the blanket and sheet down together to form a cuff.
    To ensure that the sheet rather than the blanket is in contact with the patient's skin, as the blanket could cause irritation. E
12. 17.Show
    Tuck the blanket under the foot end of the mattress, mitring the corners as before but leaving the sides of the blanket to hang free.
    To enable the patient to fold back the sheet and blanket with ease. E
13. 18.Show
    Lay pillows on the bed and replace all pillowcases.
    Applying pillowcases while the pillows are on the bed reduces the chance of neck, arm and back strain for the nurse (Lynn [115], E).
14. 19.Show
    Place the pillows at the head end of the bed.
    For patient comfort. E
15. 20.Show
    Return the bed to its original position and height.
    To maintain a safe environment and promote safety (NMC [162], C).

Post‐procedure

1. 21.Show
   Dispose of soiled linen as per local policy.
   To prevent cross‐infection (Bloomfield et al. [22], E; Loveday et al. [114], R; Moore and Cunningham [136], E).
2. 22.Show
   Dispose of apron and gloves and perform hand hygiene.
   To prevent cross‐infection (Bloomfield et al. [22], E; Moore and Cunningham [136], E; NHS England and NHSI [148], C).