incontinence

  1. Hi everybody, I'm new to the board. I am a charge nurse in LTC, have a question. In our last charge nurse meeting, the DON gave stats on the number of UTI's we have in our facility among our incontinent residents. The percentage was very high, DON has decided to have the residents wear briefs during the day when they are up and to use blue pads at night and that all residents must be prompt and toileted q2h throughout the night. 90% of our residents are alzheimer and dementia. Some can't stand on their own, our aids are expected to use a lift to get some of these people up q2h to sit on the toilet, they can't verbalize their need to urinate, they don't even realize they have voided, most of the time they require a complete linen change, which is making it harder on the laundry. The CNA's are upset, the residents are upset. I'm ready to pull my hair out. Not to mention that we are like almost every other nursing home, short staffed, some nights we have all of two CNA;s for fifty five pt. Any suggestions would be appreciated.
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  2. 10 Comments

  3. by   Sleepyeyes
    Bedpans?? Urinals??
    Bedside commodes for those who can be assisted OOB.

    Failing that, more staff. You simply cannot do all that with the standard night crew.

    PS....And you know the rest of the drill. Make them drink more. Make them drink more. Make them drink more.....
  4. by   renerian
    Sounds like an impossible feat. I have seen other facilities do the blue pads but with limited staff q2 hour tolieting will not be possible and your setting yourself up to fail from the get go.

    renerian
  5. by   judyd119
    I am a Director of Nursing myself in a SNF. In my opinion this is nonsense. Is your DON new? First of all, it is nearly impossible for an 11-7 shift to do this because of the limited # of staff available. But most importantly it is unfair to the residents. Waking them up to be toileted q2h throughout the night, when most of them don't even know what's going on is only disrupting their sleep. I'm wondering if you are seeing more behavior problems during the day. My suggestion is to have the staff request a meeting with the DON and respectfully voice their opinions. Not only is it a DON's job to ensure all residents are taken care of medically, socially and psychologically but she also has a responsibility to her staff. I've learned along the way that the front-line staff that are doing the job usually come up with way to do their jobs easier and still get the required results. Please mention to her that this practice is disruptive to the resident's sleep and can lead to behavioral problems due to lack of sufficient sleep/rest. But remember, all incontinent residents must be checked q2h and prn and incontinence care given if needed--however, this is less disruptive than getting them completely out of bed, especially with a lift and trying to toilet them. A lot of resident's still remain asleep during care. Hope this helps.
  6. by   dekatn
    Thank you for responding, I appreciate your input, last night, two CNA's threatened to walk out and never come back, I hope they were just venting!!
  7. by   ktwlpn
    Originally posted by dekatn
    Hi everybody, I'm new to the board. I am a charge nurse in LTC, have a question. In our last charge nurse meeting, the DON gave stats on the number of UTI's we have in our facility among our incontinent residents. The percentage was very high, DON has decided to have the residents wear briefs during the day when they are up and to use blue pads at night and that all residents must be prompt and toileted q2h throughout the night. 90% of our residents are alzheimer and dementia. Some can't stand on their own, our aids are expected to use a lift to get some of these people up q2h to sit on the toilet, they can't verbalize their need to urinate, they don't even realize they have voided, most of the time they require a complete linen change, which is making it harder on the laundry. The CNA's are upset, the residents are upset. I'm ready to pull my hair out. Not to mention that we are like almost every other nursing home, short staffed, some nights we have all of two CNA;s for fifty five pt. Any suggestions would be appreciated.
    What a crock! You would have a mess on your hnads of you were to physically get those dementia resident's up q2 hours.(even with sufficient staff).and it's up to you to put that bullseye on your chest and stand up fpr their rights.You are right on about the other contributing factors-your incontinent residents are probably unable to get themselves a drink-either due to physical or cognitive limitations..My LTC has certified cna's and "hospitality" aides..The hospitality aides make beds,transport and pass out drinks and snacks .They have a very flexible schedule-as many or as few hours a shift as they like and almost any time of the say.We have many older women that just love it......On my dementia unit we nurses give a full 8oz of liquid with every med pass and keep juice and ice at the desk and hand it out to whomever walks by-and we have many whom constantly wander and sip and snack all day to maintain their wt and adequate hydration...We have the lowest number of UTI's in the facility-and the numbers are low on every unit...You have a battle ahead of you-it looks as though your DON is not understanding of the challenges you face with the dementia residents...I hope you can educate her.....
  8. by   night owl
    I can't believe your DON would make you do this every two hours with only two CNA's on some nights. Is he/she out of their mind?To me this is just so unpractical and unnecessary. What is the purpose of getting them OOB? If they are cognitively impaired, their brains are damaged and at this point, what are you really trying to accomplish?
    Pushing the fluids q two hours is more important than getting them OOB in alift no less. But even waking them up to drink to me ia little cruel. Push the fluids in the day and evening. Nights are for sleeping!
  9. by   tattooednursie
    I would suggest the use of a bed pan or urinal. In my LTC there is almost 80 residents and often we have 2 CNA's. The last time that happened I was one of the 2 CNA's. Neither of us had much expiriance at all, and alot of our patients are hoyer lift patients and there is no way on earth we could get them all up every 2 hours. I like bedpans. They are so easy as opposed to up and down, up and down.

    I don't think that it is fair to the CNA's and residents. It would be impossable where I work. I just about damn near walked out that night that there was only 2 of us. I got really upset and began crying and saying "When I go home tonight, you better say goodbye because you'll never see my face again in this place." after I had my lunch, I cooled off a little and appologised to the nurses for what I had said.

    Some of the rules that the DON's make are just cruel! They must have not been CNA's
  10. by   ShortFuse_LPN
    I agree that getting the res. OOB q2h is crazy. Have you suggested an in-service for the staff who provide direct care concerning proper peri-care? (washing front to back, etc) Just an idea.
  11. by   jevans
    I agree with everything that previous posters have said.
    UTI is common with incontinence and restricted mobility. I would suggest that you target day time continence with regular toilet regime cos night time continence will always be last in returning. In my experience.

    Staff education could be the key

    BUT then more importantly is educating your Don. You can not wake people 2hrly through the night unless a medical intervention is required. Not only is it inhumane it actually increases your patients psychological wellbeing and levels of confusion. Patients should be well paded with pads that are designed to be changed as required- yes they are expensive but compared to laundry + treatment for UTI + staff cost

    Could you not do a quick check on costs and present it to the Don. Here we call it a business case- I have used it several time to change practice

    Good luck
    j
  12. by   adrienurse
    This doesn't make any sense! Makes me question whether your DON even has a background in LTC. Toileting a person q2h through the night? When are they going to sleep. You're just going to end up with a lot of VERY agitated people. How is this supposed to remedy your UTI problem? Maybe you would be better served learning together how to better detect UTIs so they don't go undetected. Hey, UTIs happen in the incontinent -- you're not gonna change that, but MY GOD! Push cranberry juice and other fluids.

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