Double Briefing

[michael79]

I recently became the nurse manager of my unit. To get myself better acquainted with the staff and their daily routine I worked all 3 shifts the past 3 weeks. One thing I have noticed is that all 3 shifts are double briefing the residents. Each shift blames the next and says "oh, I found so and so patient this way' or 'She's a heavy wetter, so we have to'. I stated that it is against state regs to double brief, but they are still doing it! What do you see in your facility and what can I do to get this to stop?

[NewNurseyGirl2009]

I am a CNA so I see the other side of this. I would never double brief a patient. They should be changed checked and cared for on demand as well as every 2 hours. Maybe staffing needs to be addressed. I know this is a hard issue but it takes real muscle and time to change a whole bed. I would make them chart everytime a patient was changed and if it had been more than two hours, they would be written up. That is not how I would want my family treated.

[Lynnette1990]

i think that is just wrong. if they wet themselves, change them don't just stick two pairs of underwear on them. if that was my family i would raise all hell. they are people, not animals. people should treat them as such.

[CapeCodMermaid, RN]

Double briefing is lazy and not even effective. The heavy wetters should get changed more frequently or, if your facility wants to spend lots of money, get the 8 hour briefs....extremely absorbent.

[OldMareLPN]

As a CNA I hated it, but I do it as a nurse for my patients.

Prior to a shift I will time and initial the inside of a brief and change a person myself.

I check later, and there is no reason to point fingers or 'they just wet stories'.

I also keep copies of assignments so if there are complaints etc. I know who was assigned.

[lovingtheunloved, ASN, RN]

Stick the staff in a pile of wet, stinky plastic and leave them there for a few hours. Maybe they'll realize they don't work at Wal-Mart stocking shelves, but that they're dealing with PEOPLE.

[beauty1216]

I work in an LTC, and I see this sort of thing all the time. Yes, it is very sad. Some residents are much heavier wetters than others. It does take a lot of muscle and energy to change a resident-especially if they are a total care resident or a mechanical lift. However, each resident needs to be changed q 2 hours or as needed. More than likely, it's a staffing issue. Low patient/staff ratio equals negligent care. In the LTC I worked at once, it was not uncommon for the CNA to have 13-17 total care residents. I did not expect all the residents to get changed every two hours on the dot-but I do expect them to be changed!

I would not tolerate my family being treated like that, and I wouldn't expect anyone else's family to be treated in that manner either. Have a meeting with the staff, and explain the importance of the residents getting changed and not getting "extra briefs" instead. Stupid as it sounds, sometimes people need a reminder of their selfish actions. If the residents are found double briefed after two hours of the next shift, the CNA on duty should be wrote up.

Also I must mention that some of our residents have a Doc's order for "inserts" because they are such heavy wetters. Some families actually request thier loved ones get "extra protection". There are only a few residents in my unit who are supposed to have on inserts. Anyone else found with one is an immediate write up for the CNA.

[LoveMyBugs, BSN, CNA, RN]

When I worked in LTC, I had a resident that I would sometimes take care of that wanted to be double briefed in fact she wanted 3 put on. Her reasoning was that she wore the pull ups and if she wet during the night she didn't want to get up and take off her pj bottoms and put on a new pair of pull ups. She would just want you to come in and take off the wet pull ups. However she would get so mad when we wouldn't double brief her.

Other than that resident, double briefing is horriable. What we had to do was on our last rounds put the time and inital on the brief. There was one shift I remeber working ( started at 3pm) and I had 4 residents with a 6:30am time on them. The day shift CNA hadn't changed or checked any of her residents. Needless to say the CNA didnt last much longer

[casi, ASN, RN]

I'll admit this is something I used to o occassionally with incontient/combative patients. It was a lot safer to stick two pairs of briefs on them when they were in a good mood because the next time they wet they could be getting aggitated an combative, so it was easier to get the clean brief off and a dry one on.

Without this they would be getting rarely changed.

[CoffeeRTC, BSN, RN]

First off....how is is easier? I think it is mroe of a struggle. When I was a CNA for a year, I followed a CNA that did this. I watched her do this and maybe it is me, but is is much more of a stuggle to clean and take the old brief off.

Just wondering...do you also use bed pads? The heavy wetter excuse doesn't float. If you had a pad down, that would catch the extra.

Another thing to consider...what type of briefs are you using? Maybe the ones you are using could be cheaper and not even hold up to the 2 hrs standard.

[nightmare, RN]

Our management has gone down the extreme route of issuing out only one weeks pads at a time.Each resident is continence assessed and then,if they are assessed for three pads a day they are only issued with 21.hard questions are asked if they run out before the next issue.If they are regularly running out of pads then they are reassessed for a bigger size.

[CapeCodMermaid, RN]

Here is an aside. Who ever came up with the toileting/changing every 2 hours? It is NOT normal to be put on the toilet every 2 hours. I don't know one person who actually pees every 2 hours. Again we carry on with outdated standards because no one has the nerve to question what's 'always been done'.