To prevent sacral ulcers in immobile patients, which positioning is recommended?

• A. Position the patient prone with a small pillow under the diaphragm
• B. Keep the patient in high-Fowler's with no pillows
• C. Use massage to sacral area hourly
• D. Encourage patient to reposition themselves every 4 hours

Answer: (A)

Relieving pressure on the sacrum is how you prevent sacral ulcers in people who can’t move themselves. The sacral area is a common site for pressure injuries when someone stays in one position for too long, so you want options that redistribute weight away from the sacrum and reduce continuous pressure.

Being in a prone position shifts weight off the sacral area onto the chest and front of the body. Adding a small pillow under the diaphragm helps maintain comfortable chest expansion and proper alignment while the patient is on the stomach, which supports staying in that off-loaded position more comfortably and safely.

By contrast, staying in a high-Fowler’s position keeps the person mostly upright and can increase pressure on the buttocks and sacral region. Massaging the sacral area isn’t a preventive measure for ulcers and can cause skin irritation or damage, especially if the skin is fragile. Repositioning every 4 hours is often not enough to prevent ulcers; turning every 2 hours or per protocol better reduces the time any one spot is under continuous pressure.

So the recommended approach is to position the patient prone with a small pillow under the diaphragm to offload the sacral area and support comfort and breathing, helping prevent ulcers.