[Town & Country]

Does your facility leave incontinent residents in Depends (or adult diapers) at night?

[VivaLasViejas]

When I was a care manager in LTC, I used to insist on leaving my residents OUT of Depends at night. I'd seen way too many skin issues crop up when peoples' hineys were encased in plastic---which all too often was WET---for eight or ten hours a night. We even had some really lazy staff members who'd change the bed pad at 0600 to try to fool whoever checked them into thinking the residents were dry, when they were in fact sopping wet, and indeed had been all night But that's a story for another thread......anyway, I'm a firm believer in keeping skin open to air as much as possible, and nighttime's pretty much the only time to do it.

[catlady]

Originally Posted by mjlrn97

When I was a care manager in LTC, I used to insist on leaving my residents OUT of Depends at night. I'd seen way too many skin issues crop up when peoples' hineys were encased in plastic---which all too often was WET---for eight or ten hours a night. We even had some really lazy staff members who'd change the bed pad at 0600 to try to fool whoever checked them into thinking the residents were dry, when they were in fact sopping wet, and indeed had been all night But that's a story for another thread......anyway, I'm a firm believer in keeping skin open to air as much as possible, and nighttime's pretty much the only time to do it.

Heh, and when *I* was a unit manager, I made the same order to my staff, only to have it immediately countermanded by the DNS. She insisted on diapers at night and had it written as facility policy. Heck, I'm not much crazy about them wearing diapers--excuse me, incontinence briefs--during the day. Diapers mean fewer toileting trips. Of course, the facility needs to provide enough staff so that people really can be toileted appropriately.

[VivaLasViejas]

Originally Posted by catlady

Heh, and when *I* was a unit manager, I made the same order to my staff, only to have it immediately countermanded by the DNS. She insisted on diapers at night and had it written as facility policy. Heck, I'm not much crazy about them wearing diapers--excuse me, incontinence briefs--during the day. Diapers mean fewer toileting trips. Of course, the facility needs to provide enough staff so that people really can be toileted appropriately.

I hear you, catlady loud and clear! I remember interviewing at one nursing home where I learned that briefs were used on ALL residents, day and night.....whether they were continent or not. I spoke with a few of them, one of whom was a 43-year-old female CVA pt. in the rehab unit, and they even put HER in diapers despite the fact that she had only minor neuro deficits from the stroke, and had been completely continent even during her hospital stay. I told her right then and there that she didn't have to put up with this indignity.......naturally, I don't imagine that found favor with my interviewer, but I didn't care because I wouldn't have accepted the job anyway.

[TriageRN_34]

Our incontinent residents use go betweens (pinkies as they call them, those thick cotton pads) at night, and normally do use the call light system for tolieting or they are on 1 hour to 2 hour checks at night. Wearing those types of garments at night cause huge skin issues, we don't allow them overnight (also for the reason of caregivers not tending to residents often if they have a 'depends' on so why worry...uhggggg!).

This is a facility policy, and signed by the resident and/or family representitive at time of incontinent services, and is part of their service plan. So far no modesty factor has come to play...people don't seem to mind it because it is an easier change most times than an entire depends off/on, so quicker they go back to bed.

But our facility is overly skin cautious...and if one single LITTLE skin issue arises (including a less than dime shaped bruise or 0.5 cm skin abrasion!) it is tons of paperwork, incident reports, monitoring till fully resolved and so on..so lots of motivation for residents and staff to stop things before they happen!

[redwinggirlie]

But our facility is overly skin cautious...and if one single LITTLE skin issue arises (including a less than dime shaped bruise or 0.5 cm skin abrasion!) it is tons of paperwork, incident reports, monitoring till fully resolved and so on..so lots of motivation for residents and staff to stop things before they happen!

As a skin care nurse I've seen many of those tiny .5 skin tears turn into much more.... good for your motivation factor where you work.

[LPN01112005]

At my facility, every incontinent person (which is 90% of the residents) wears incontinent briefs at night. If they have Stage II or above pressure ulcers they are left to air during the night with a pad underneath. I know this isn't the best course of action to deal with skin breakdown, but at my facility, we are so short staffed at night......4 CNA's to 120 residents, that we wouldn't be able to keep anyone dry or the beds changed if the incontinent residents were not in briefs. We do try to adhere to a 2 hour turn & change schedule. I don't know when our DON is going to get off her *** and do something about the staffing problems on 11-7. She transferred some CNA's to day shift to cover day shift's required 16 CNA's without even posting a job opening for the two positions left open on 11-7 not to mention the two positions that were already open. I can't count the times that we have run our facility on 11-7 with 2 nurses and three CNA's. 11-7 is the forgotten shift that gets blamed for every bit of skin breakdown and other bad outcomes. I love my job and my residents, but I keep waiting for my much appreciated (by me anyway) CNA's to just walk out because they can't take it anymore.

[not now]

You can but I don't. Where I work I have to ask a LVN for a brief so they are regualted pretty well. Some people will leave residents in briefs until the last round and I hate it. God knows how many blisters on the hips I've seen from residents in briefs.

I keep my residents dry by putting a Geri-pad under them and doing my rounds every two hours. Most of my patients cannot hit the call light or even ask to use the restroom so keeping an eye on them is the best way to do it. I rarely have a complete linen change and when I do it's usually because they moved around in bed and wound up off the pad.

[CapeCodMermaid]

Never is the saying "An ounce of prevention is worth a pound of cure" truer than in skin care. So much easier to do the changes whether briefs or soakers, and turn the resident often, than to try to heal a stage 2 or 3. I don't like briefs at night, but budgetarily (is that a word?) speaking, it's less costly than buying boxes of cloth soakers and doing the laundry.

[michelle126]

I don't like the idea of briefs on everyone in bed, but our DON insisted that if the resident wants them, we they get them. Also our diaper representative (not sure what brand we use Tenna?) insists that they will not cause break down because they wick the urine away. I still insist on keeping diapers off of res with skin probs (decubs, excoriation, etc)

As far as ease..it is much easier to use the pads than wrestle and wrangle some residents in the middle of the night puttting attends on. Now don't even get me started on the CNA who feels 2 diapers are better than one