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Anyone else having an 'explosion' problem?

By explosion I mean every resident on all of our halls (minus a few) are having diarrhea, MASSIVE. I'm talking you lift the sheets up and there is a pool of stool inbetween their legs.

I obviously have a strong stomach to this stuff, otherwise I wouldn't be in this field, but it's the time it takes to clean up one diarrhea resident that is stressful, not the actual diarrhea itself.

The past two days i've been having to start my last shift early and STILL end up going overtime, even THEN I have to leave without finishing everyone because the nurse tells me just to leave and don't worry about it.

I have to clean about 14 residents, a little over half of whom have diarrhea which can take up to 30 or more minutes to clean because I have to keep going back for another bag of wipes and do a complete bed change on all of them, and I had a couple make an accident after I change the sheets and before I put a clean diaper on.

Have any of ya'll experienced this? What do you do to make sure you finish everyone on time?

Winter. Every winter.

Get a cart, make "packages" of linens - pillowcase, fitted sheet, flat sheet, draw sheet (and maybe even a few bedspreads), stock it with some briefs, chux, and ample containers of wipes, and leave it outside every room you go into. Saves lots of time running back and forth for supplies. You can even make pre-made "rolls" of draw sheets and chux.

When the end of your shift comes around, leave the rest for the next shift, no matter how much they moan and complain. Residents can't and won't just hold their poop in simply because it's shift change (no matter how many times I plead with them to hold it 5 more minutes until I can clock out, it just never works ;)).

One time a nurse in our facility didn't properly chart that she had given the residents Milk of Mag and then the next nurse on gave them more....so they all got double-dosed. I remarked at the end of my shift at how much ca-ca I had to deal with and that's when I found out why. Funny because the nurse that flubbed up is a total 'bee-otch' who's verbally abusive to all the new CNA's. I always thought she seemed kinda scary until I realized that she's nothing to be intimidated by. Anyway....sometimes when you're up to your elbows in doo-doo it's either because of gastroenteritis or laxatives. Either way it can make for a pretty crappy shift. As far as finishing on time.....it's more important to do a good job on the ones you clean than to do a poor job just to get done in time. You're only one person after all !

The last facility that I worked for had a fit if we used chux under our residents, so I would make sure to put a draw sheet under some of my residents that had issues with the bowels. Something that my fellow aides told me was to use shaving cream on the peri areas when residents have an accident and that works great. Just make sure the nurses are okay with you using shaving cream with your residents.

fuzzywuzzy, CNA

Has 3 years experience. Specializes in LTC.

I can relate. This has happened to me several times, and it does seem to be a winter thing. Normally if someone has a blow-out like that I give the person a shower (much to the chagrin of my coworkers who don't like to give anyone *extra* showers), but on days like that it's just not feasible. Like Coffeemate said, throw tons of supplies at the end of everyone's bed. On second shift I would just put everything at the foot of the bed under the covers or rolled up in a blanket so it didn't look like a hot mess. On first shift I leave everyone in bed as long as possible. Chucks are your friend, and since my facility doesn't have wipes or shaving cream, I use toilet paper to wipe most of it up and then I clean them with lotion and soap mixed together. A nice coating of barrier cream helps too. I like to lay the person on the chuck and lightly pull it up between their legs so the poop doesn't go all down their legs, but not so tight it'll go up their crotch.

CT Pixie, BSN, RN

Has 10 years experience.

Tis the season..every year around this time.

We are currently doing the whole runny/loose/diarrhea thing..the other floor has the respiratory thing (sounds like a TB ward!) . I bet you anything in a week or so the other floor will be doing the GI thing and we'll have the resp issues!

but yes, I bet a majority of the facilities are dealing with it. Like I said..tis the season..every winter.

I was referring to throwing everything on a linen cart and dragging it around the hall with you, but keeping the specific supplies you need in each room is also a great idea, fuzzywuzzy.

OP, if a linen cart or other type of cart is not available, you can use someone's wheelchair as a makeshift one. The reclining kind works best, if available. Overbed tables, while not as large, can also be handy.

Don't forget to stock it with gowns and trash bags as well.

If you are running low on wipes or washclothes, and if the resident's gown is already soiled, you can start cleaning them up, change their gown, and use the "clean" parts of the "dirty" gown to finish get them cleaned up. If the gown is already soiled, what's a little bit more BM for it? It's going to have to be washed anyways. :D

Some residents don't have much stuff and may have extra space available in their closets or drawers. In those cases, you can put the supplies directly in the drawers. It's handy, and you don't run the risk of fellow aides, nurses, or admin coming and whining about your rooms/hall being an eyesore.

Ev1987

Has 4 years experience. Specializes in LTC/Rehab.

Sometimes that happens during our rehab unit when there's a G.I. bug going around. Or when nurse aides aren't charting resident's BM's, so the nurses are handing out 'milk of magnesia'.

bhanson

Has 2 years experience. Specializes in Cardiac.

On our acute care unit we don't use diapers--especially for incontinent patients because it is bad for their skin.

I know exactly what you're talking about concerning those 30 minute changes. It is impossible to remedy an explosion quickly when they're on isolation, obese, have a chest tube, and further more does not tolerate a low HOB d/t exacerbated COPD or something. Thankfully these are few and far between since it takes some special conditions for a change to take that long. The worst is the sticky BM that feels impossible to get off.

Most of the high volume cases are not of the sticky variety so 10-15 minutes is usually sufficient. What we usually do is first stick a towel between their legs to help soak up the majority of the BM. If the genitalia is covered in BM then do a quick "volume" wipe up but don't try to clean them thoroughly yet. Turn them to the side and do another volume wipe up of their bottom; it's okay to use the remainder of the dirty pad here.

If it is indeed high volume, we find it is easier to put another pad under them just to do the changing because during turning it is too easy for the BM to leak and dirty freshly cleaned skin. With the soaked pad out of the way and the majority of the BM gone, now it is pretty much just like a normal change.

We have super thin, super absorbent disposable pads so in these cases we usually use more than one to avoid dirtying the bottom sheet. You can also leave a small towel just anterior to the anus to prevent the BM from touching the genitalia.

yousoldtheworld

Has 5 years experience.

Apparently this is the week of the explosions at my facility, too. And my wing is all tube feeds, so it's the sticky, take a whole pack of wipes to get off, gets all over the place kind of poop. AHHHHHHHH. :mad:

KimberlyRN89, BSN, RN

Specializes in Med-Surg/urology.

Sometimes that happens during our rehab unit when there's a G.I. bug going around. Or when nurse aides aren't charting resident's BM's, so the nurses are handing out 'milk of magnesia'.

At my last facility, one of the nurses flat out told me " I don't have time to read your books!"..well if you don't read them, than how do you know whether or not the resident's have had BM's?:uhoh3::uhoh3:

CT Pixie, BSN, RN

Has 10 years experience.

At my last facility, one of the nurses flat out told me " I don't have time to read your books!"..well if you don't read them, than how do you know whether or not the resident's have had BM's?:uhoh3::uhoh3:

Wow. I'm a nurse and I think it would take more time and energy to dose up all the residents with Milk of Mag or whatever the med of choice is than to just take a quick glance at the BM book and see who actually NEEDS it. I dread having to give milk of mag or a suppository or worse yet the dreaded enema! The patients hate it, fight about it and it just sucks up a lot of valuable time doing it..especially if its not needed. Big thumbs down to the nurse who said that!

Oh jeez, I'm in my CNA clinicals right now and won't finish up until late next month...I sure hope the explosive pooping doesn't start while we're there! But then again, guess we'll learn how to deal with it!

Hope I'll have my gag reflex turned off that day...

Ev1987

Has 4 years experience. Specializes in LTC/Rehab.

At my last facility, one of the nurses flat out told me " I don't have time to read your books!"..well if you don't read them, than how do you know whether or not the resident's have had BM's?:uhoh3::uhoh3:

About seven months ago, we started charting electronically. So resident's who don't have a bowel movement in 3 days are automatically in the nurses computer system, labeled as 'bowel protocol.' Plus, before handing out the M.O.M, they would ask the resident's 'When was the last time you had a BM?"

About seven months ago, we started charting electronically. So resident's who don't have a bowel movement in 3 days are automatically in the nurses computer system, labeled as 'bowel protocol.' Plus, before handing out the M.O.M, they would ask the resident's 'When was the last time you had a BM?"

That's what our facility uses. Hand-held computers that you take with you and chart as you perform cares. We also still use a BM book and usually the nurses check that before they check the computer log because it's faster.

fuzzywuzzy, CNA

Has 3 years experience. Specializes in LTC.

There's on nurse on the shift before mine who doses EVERYONE (right before we come in, of course) with MOM and suppositories if they haven't had an extra large BM in like, the last 4 hours. It's ridiculous. Most of them don't need it and they spend all day flipping out, probably because they feel like they're going to sh*t themselves.

yousoldtheworld

Has 5 years experience.

Our kids get enemas if they have not gone in 3 days. Normally on most nights, there are a few enemas per wing given. However, we write the residents' output on the sheets we turn into the nurse at the end of the shift and the nurses are supposed to mark the output down in their books.

We do have a couple of nurses who are famous for missing bms on the paper, but for the most part, the system works.

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