Pre‐procedure

ActionRationale

1. 1.Show
   Collect all the equipment listed and place it by the bedside. If available, use the linen tray at the end of the bed to store the clean linen, or a clean chair beside the bed within comfortable reach. Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
   To ensure efficient time use, reducing the need to leave the bedside (Bloomfield et al. [22], E).

   To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [162], C).
2. 2.Show
   Assess the patient for any mobility restrictions and pain to be sure that the patient is able to tolerate movement. Analgesia may be required.
   To promote patient comfort (Spencer [217], E).
3. 3.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 (NHS England and NHSI [148], C; Pegram and Bloomfield [22], E).
4. 4.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).
5. 5.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).
6. 6.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. 7.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. 8.Show
   Remove unsoiled, reusable linen (blankets etc.) and fold them over a chair or place them on the tray at the end of the bed. Ensure that the patient remains covered with a top sheet. Apply a clean top sheet if required.
   To keep these items near to hand so they can easily be used later in the bed‐making process. E

   To preserve dignity and privacy (NMC [162], C).
3. 9.Show
   If it is raised, lower the bed side nearest you. Loosen the bottom sheet by moving methodically around the bed from the head to the foot. Ask the patient to roll on to their side (side rails can be used if available). Ensure that the second nurse is on that side to offer assistance if the patient is unable to roll independently. Adjust the pillow and ensure that any tubing attached to the patient is not being pulled or stretched.
   To avoid the nurse stretching across the bed, potentially causing back injury (Davis and Kotowski [48], R).
4. 10.Show
   Roll the soiled sheet into the centre of the bed towards the patient and tuck it under the patient's shoulder and buttocks as much as possible. Avoid shaking the soiled linen.
   To prevent the spread of micro‐organisms to the environment via airborne or contact means (DH [49], C; Lynn [115], E; Pegram and Bloomfield [22], E; Potter et al. [188], E).
5. 11.Show
   If soiled, clean the mattress as per local policy. Check the mattress to ensure integrity of the covering.
   To ensure the mattress is in good condition and avoid cross‐contamination of the clean linen (NHS England and NHSI [148], C; Windle [241], E).
   Place the bottom sheet on the mattress and open it out so that the centre crease is running down the middle of the mattress. Cover half of the mattress and ensure that the sheet is smooth. Tuck in the sheet to the mattress, mitring the corners (see Procedure guideline 9.5: Making an unoccupied bed for how to do this). Fan‐fold the remainder of the sheet vertically and place it alongside the patient, keeping the clean and soiled sheets apart.
   To avoid cross‐contamination of clean bed linen from the soiled sheet (NHS England and NHSI [148], C; Pegram and Bloomfield [22], E; Wolfensberger et al. [242], E).
6. 12.Show
   Keeping the patient covered, ask the patient to roll back and onto their other side. Advise that they will feel that they will be a rolling over a roll of linen when they do so.
   To preserve dignity and privacy (NMC [162], C).
7. 13.Show
   Remove the soiled bottom sheet. Gather it into a ball, rolling the soiled area into the centre of the ball. Clean and dry the mattress if soiled as per local policy. Dispose of soiled linen in the linen skip, holding it away from your uniform. Change gloves if soiled.
   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; NHS England and NHSI [148], C; Potter et al. [188], E).
8. 14.Show
   Pull the fan‐folded clean linen from beneath the patient towards you and spread it out to provide a smooth surface across the mattress.
   To provide a smooth surface for the patient to sleep on, avoiding discomfort for the patient and the potential formation of pressure damage (Bloomfield et al. [22], E; Lynn [115], E).
9. 15.Show
   Mitre the top and bottom corners of the sheet and tuck the remaining sheet under the mattress.
   To secure the position of the sheet so that it does not move. E
10. 16.Show
    Place a clean top sheet lengthwise over the patient with the centre fold vertically down the centre of the bed. Open the sheet from the patient's head to their feet.
    To maintain patient dignity. E
11. 17.Show
    Ask the patient for their preference: 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
12. 18.Show
    If required, 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 placed as per the patient's preference.
    To promote patient comfort. E
13. 19.Show
    Fold the blanket and sheet down over 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
14. 20.Show
    Change the pillowcases. Ask the patient to raise their head; supporting the patient's head with your hand, remove the pillow. Lower the patient's head to the mattress. Remove the soiled pillowcase and dispose of it directly into the linen bag. Clean and dry the pillow if soiled, and replace the pillowcase. Ask the patient to raise their head, support their head with your hand and replace the pillow.
    To promote patient comfort. E
15. 21.Show
    Adjust the position of the bed to suit the patient's preference and/or any clinical requirements.
    To promote patient comfort. E
16. 22.Show
    Return the bed to its original location (if moved) and height. Ensure that the call bell cord is available to the patient and position the bedside table to be accessible to the patient.
    To ensure a safe environment for the patient (Bloomfield et al. [22], E).

Post‐procedure

1. 23.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. 24.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).