Double Briefing

Posted
by CuriousCNA CuriousCNA (New) New

So I've been hearing a lot about this lately and I have searched and searched to find state regulations or codes or laws or anything that says in black and white "double briefing is illegal".... And I'm still empty handed. It's been a fighting subject at my current place of employment and I'm just curious, is it illegal to put two briefs on residents that urinate excessively? or is it just morally wrong...

NurseOnAMotorcycle, ASN, RN

Specializes in Med-Surg, Emergency, CEN. Has 10 years experience. 1 Article; 1,066 Posts

Why? It's cruel and unhealthy. It causes skin breakdown, pressure ulcers, promotes UTI, yeast growth, staph infections, abrasions in the groin where the edges are rubbing against the skin. It encourages laziness among caregivers which increases the likelihood of the aforementioned complications.

I hope your coworkers do not do this! I never even attach briefs unless they are being transported out. I just leave them open under the patient. It's not illegal, it's Basic Nursing Care.

skin breakdown briefs diapers - Google Search

Edited by NurseOnAMotorcycle

CelticGoddess, BSN, RN

Specializes in Palliative, Onc, Med-Surg, Home Hospice. Has 6 years experience. 896 Posts

When you double brief, you increase the risk of skin breakdown, infection etc and I think it is just plain lazy. We don't use briefs any more at my facility (acute care). We only use covidiem pads under the patient and we are having to change those 5 or 6 times per shift. However, the patients keep dry, and isn't that what is most important?

BTW: Briefs also increase the risk of yeast infections, having the area open helps prevent that. We have had some long-termers who got yeast infections regularly while wearing briefs, once we stopped with the briefs, the yeast infections decreased considerably. Granted, this is anecdotal so take it as you will.

Is it illegal? Probably not but it is definitely wrong!

Kitiger, RN

Specializes in Private Duty Pediatrics. Has 43 years experience. 1,706 Posts

I assume covidiem pads are what we used to call Chux, a flat disposable bed protector. In the hospital, that might work except for those patients who urinate large amounts less often. They are not at all adequate for those residents who are up and about.

We use diaper liners - large, flat pantiliners - to capture everything for those who need it, while they're up and about. Briefs need to be checked regularly, every one or two hours and PRN.

I agree it's best to leave the brief open when you can while the resident is in bed.

CuriousCNA

CuriousCNA

3 Posts

So using a pad or liner for heavy wetters is ok then, as long as it's checked regularly and not left in all night. I mean I assume that all of those issues in the first two comments can still occurs in single briefs too if they aren't checked enough. So those aren't good defense topics for double briefing. I understand that it's not nice or morally right to leave a resident wet for too long, if you can change them and aren't busy then yes of course. But for the sake of bed strips and saving a roll on a stiff patient or some that are in the fetal position, a liner or pad inside the brief is acceptable. Cause there's nothing legally saying no it's unacceptable. It's not neglect or abuse (when changed appropriately)

CuriousCNA

CuriousCNA

3 Posts

Unless I didn't find something that someone else found on the legal side of things, please post it I would like to read it

AceOfHearts<3

AceOfHearts<3

Specializes in Critical care. 916 Posts

But for the sake of bed strips and saving a roll on a stiff patient or some that are in the fetal position, a liner or pad inside the brief is acceptable. Cause there's nothing legally saying no it's unacceptable. It's not neglect or abuse (when changed appropriately)

Are you turning and repositioning those patients at least every 2 hours? Most of the patients I get (acute care) that are incontinent need Q2 turns as well, so cleaning them up is the perfect time to do the turn and reposition.

NurseOnAMotorcycle, ASN, RN

Specializes in Med-Surg, Emergency, CEN. Has 10 years experience. 1 Article; 1,066 Posts

So using a pad or liner for heavy wetters is ok then, as long as it's checked regularly and not left in all night. I mean I assume that all of those issues in the first two comments can still occurs in single briefs too if they aren't checked enough. So those aren't good defense topics for double briefing. I understand that it's not nice or morally right to leave a resident wet for too long, if you can change them and aren't busy then yes of course. But for the sake of bed strips and saving a roll on a stiff patient or some that are in the fetal position, a liner or pad inside the brief is acceptable. Cause there's nothing legally saying no it's unacceptable. It's not neglect or abuse (when changed appropriately)

Oh Heaven help those patients. I can't even count the number of things wrong with this whole statement. If you are doing this, please stop. Turn q2 hours, leave total care patients' briefs open to air. You are in the healthcare business, not the "trying to get out of doing anything" business.

If you feel that it's ok to NOT move a stiff patient or to leave them in a brief until "if you can change them if you aren't too busy" because you feel that "it's not illegal" then PLEASE quit your job immediately!!!

Edited by NurseOnAMotorcycle

Here.I.Stand, BSN, RN

Specializes in SICU, trauma, neuro. Has 16 years experience. 5,047 Posts

Think about how non-breathable a brief is...I mean the waterproof outer lining is plastic. Double briefing adds a second layer of plastic, making the product twice as non-breathable. Then consider that alllllll this urine from the heavy wetter is being held inside by not one, but two layers of plastic. It's a recipe for skin breakdown and Candida infections

Here.I.Stand, BSN, RN

Specializes in SICU, trauma, neuro. Has 16 years experience. 5,047 Posts

And what's this about if you have time? You make the time. That's your job.

And yes, I have been a CNA in LTC with more patients who were incontinent than not. Turning q 2 hrs and changing their pad was a given, no matter if we were working short (2 CNAs to 30 residents), no matter if we'd had a tornado warning and got behind on our work.

You know what? I went through five years of pre-nursing healthcare never having seen a pressure ulcer... (except for the A&Ox4, 50 yr old CP-related quad -- he would spend the whole day in his head-controlled wheelchair. His choice which resulted in a stage III.) Even the 68-lb little bird who was wheelchair bound had intact skin because we were so diligent about turning and changing every 2 hrs.

crazin01

crazin01

Specializes in tele, ICU, CVICU. Has 12 years experience. 280 Posts

The previous posters are absolutely correct here: it's not good nursing care, no matter how short-staffed or hectic the shift may be.

I always treated patients like they were a member of my family & cannot say how many times my conversations with somewhat lazy staff started with "my grandparents have both been patients on this floor & this is not adequate care for them".

I must confess I primarily responded to the OP to give you all a good chuckle...

When I first saw the topic of your post, I misread it and thought you were asking about a debriefing meeting, following an very stressful incident...

(sorry, my brain needs sleep!!!) :sleep:

Edited by crazin01
typo