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| |  daily baths?
Hi, I am brand new to rehab nursing management and new to this site! I am looking at a few things regarding our clinical practice at our rehab hospital and patient bathing is one of my top priorities. The health dept had a patient complaint about a year ago and I want to make sure that the problem is resolved. As a result, the supervisors keep a bath log but the process has not been improved. I haven't been able to find much data on the subject or in evidence-based practice and I am curious what other facilities are doing.
Are your patients bathed daily or every other day?
Is nursing or OT responsible? How is the workload divided up between the shifts and staff? I realize that there is a heavy workload placed on staff but it bothers me tremendously to discuss decreasing infection rates and hospital acquired infections, etc. when patients are receiving daily bathing. How can we assess our patients accurately for FIMS scoring and get them home to return to ADL's without daily bathing in rehab?
I appreciate any insight you can offer to me before I address this in my new position. Currently patients are bathed every other day and OT is responsible for the first bath. I am very concerned because the documentation indicates that patients are not even getting a bath every other day after that! Incomplete documentation is in part the problem and unfortunately there are some accountability issues as well as turf war between nursing and therapy. I just want our patients to receive the care they deserve.
I shower daily and I would hate to think that when I enter the hospital I would have to be on the every other day plan!
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| | Advertisement Sponsored Links | | | | No. 1 | 
Aug 05, 2008, 10:31 AM
Re: daily baths?
I work in a 20-bed acute care rehab unit and our patients get daily showers (when appropriate), unless they refuse, then we at least attempt to get them to wash at the sink or in bed/at bedside. Half of our baths are done on day shift, half on evening shift; it is nursing's responsibility to do the baths. It gets difficult, and we considered going to all evening baths and having an additional bath aide, but that was not in the budget, so we continue. Day shift does the baths, nurses help when possible, otherwise it is the aides who do most of these (we need to get insulin, meds, dressing changes, get people up and down for breakfast, have glucos done, AM supps for some, dressing for those nursing is responsible for, and then the showers... it gets very hectic). Patients who have early morning therapies (by schedule or if they have dialysis, procedures scheduled, require more time, etc) get evening baths. Evening shift staff are responsible for PM bathing, PM cares, undressing, evening assessments, etc. We do have EMRs so that helps to see what time it was done, what was done, who did it, etc. That's generally how we do it on my unit. PM me if you want more details. Hope that helps!
| | No. 2 |
Aug 09, 2008, 01:56 AM
Re: daily baths?
I work in subacute rehab, and the patients receive showers 3 times weekly. The bathing responsibility falls upon nursing. Since there are about 35 patients on this unit divided between three CNAs, no time exists for daily showers.
To curtail the spread of infection, our facility stopped giving whirlpool baths. Only showers are to be given, because the whirlpool sometimes didn't get thoroughly cleaned between baths.
| | No. 3 |
Aug 11, 2008, 09:02 AM
Re: daily baths?
Funny that you should ask this question because it has been an issue of debate on my rehab unit recently. I've been working on this particular unit for about 1 year. We have never followed a bathing schedule for showers, but patients were showered upon request. Patients are usually bathed by sponge baths, or set up in the bathroom. The first and second shift do this. Recently, we had a family member complain that a patient had been with us for a month, but did not recieve a shower the whole time. Our manager made a shower with weighing schedule that has both being done on first and second shift. So, basically each patient is suppose to get a shower at least once a week. More often is they request. We recently met with the vp of nursing because we are having difficulty with our staffing guidline....which is another story...and she said showers should be done in the evening. The day shift has to get patients through breakfast and lunch and ready for therapy by 9:00. We are still working on the schedule. OT doesn't get involved with showering people that often. You would think they would, but I don't see it happen.
| | No. 4 |
Aug 11, 2008, 07:35 PM
Re: daily baths?
Thanks, I really appreciate all of your responses. I find it interesting that we are dealing with the same struggles regardless of our regions. Our facility currently keeps a log of patient's bath/shower in addition to the documentation in the chart. It seems like the answer to every challenge has been to throw more documentation into the problem! I would like our facility to proact instead of react.
Also does anyone have a copy of a good working kardex to share? We are not computerized and the current kardex in use is awful. Often times labs and tests are missed and I'm not surprised given the tools the nurses are working with.
| | No. 5 |
Aug 26, 2008, 07:28 AM
Re: daily baths?
Hi,
Bathing is also a major problem in our facility and one of the reasons is people FORGET TO CHART THEM! Lately we have had MAJOR complaints from family members, also!
We have no proof it it isn't charted!!! This is especially difficult when a confused patient tells their loved ones they haven't had a bath/shower in a WEEK (and we know it's NOT true--ugh!)
Our DON started a new system that MIGHT help you at your facility. On the board where all the patients are listed, it is written when their next bath/shower is due (our protocol is every other day also), and they designate whether nursing or OT will be doing it. This makes things SO much easier on the always hectic day shift! In the past, a tech might assist a patient w/ a bath in the morning only to have the OT arrive an hour later wanting to do it....arrggghh!!  (same with dressing, but that's a whole other rant! LOL!)
We also have the antiquated paper charting, also.....ugh, I cannot WAIT until we go computer!!
Good luck!  | | No. 6 |
Sep 09, 2008, 08:50 PM
Re: daily baths?
This response may be too late, but we have a " shower schedule". Our residents recieve bi weekly showers and bedbaths during the week. The bedbath is part of the rehab, set up and assist as needed. We recently have been asked to add the showers to our house report that goes to the nursing office. How we work the schedule for showers is, we have all semiprivate rooms. The day shift showers the "A" side of the room and the evening does the "B" side. We do the same with the weekly weights! It has really been working out much better since the CNAs know that the residents showers have to go on the house report! The charge nurse uses the scedule to assign the CNAs.
| | No. 7 |
Nov 08, 2008, 04:50 PM
Re: daily baths?
Pts in bed 1 are showered on odd nights and pts in bed 2 are showered on even nights. We have only 4 private rooms, while the rest are semi-privates, so 2 of the privates are showered on even nights. By this, I mean the showers are done by the 3-11 PCTs. The PCTs also do the shower after the bowel program is done. Most have a nightly suppository even if they are showered QOD. There is also a laminated sign in the room informing pts and families of their designated showers. We do computerized charting, so the RN & PCT can chart what is on their task list. If I get to it first, it drops off the PCT lidt, do there is no double charting, but of course, I have double the amount of tasks with wound care, teaching, etc!
| | No. 8 |
Nov 22, 2008, 11:04 AM
Re: daily baths?
Hello all,
Your comments about various guidelines for bath care of rehab. patients are very interesting and helpful. My current private duty home health patient is a "rehab type" patient in that he is only 18 years old and is a quad due to a car accident one year ago. This patient lives in the home of his parents. This patient's Mother has said that her plan of care for bathing him is for the nurses to give him a shower once per week(using Hoyer lift and special waterproof sling), and give bed baths on all the other days. Each shift I work, I always offer to give the patient a bath--if the patient refuses a bath(which did happen to me one work day this week), I document the offer of bath and the patient decline and kindly share this patient response with the patient's Mother. (Hey, when I am off work sometimes I take a shower every other day---in my humble opinion, bath every other day with cleaning of diaper area at every diaper change is very reasonable patient care)
In closing, will "vent" that as retirement aged nurse have just three months ago started working again by taking this job with home health "rehab. type" patients and am finding this EXTREMELY depressing work!(my current plan is to look at this job as another learning experience in life, do my very best to care for these gloomy patients, and kindly exit at the one year of service point)---hats off to all of you who work with rehab. patients!--take a bow! Peace to all of you.
| | No. 9 |
Nov 26, 2008, 09:50 AM
Re: daily baths?
What EMR system are you using and is your facility CARF certified? We are looking at EMR systems for our free standing rehab facility to meet the CARF requirements.
Thanks-
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