Double Briefing

jwolansk · Nov 30, 2016

I have never considered if this is illegal. I work in LTC and we have pads we put inside their briefs. How is that different than two briefs? I always do rounds every 2 hours and turn/reposition. So I am wondering if they are still at risk for the breakdown and infections is they are being taken care of on time?

Glycerine82, LPN · Dec 1, 2016

It's considered one of the seven types of abuse - neglect. Patients who are incontinent need to be changed and cleaned ASAP, and a barrier cream re-applied, in many cases. If the two briefs are because the patient is an exceptionally heavy wetter, thats a different story, but would need to be brought up to the nurse who could come up with a plan, etc.

JasBSN · Dec 1, 2016

I work in LTC, we recently had a rep from the company who makes the briefs we use come in and inservice our CNAs. If a brief is leaking and you feel like the resident needs to be double briefed, you are most likely using a size too big. A standard brief can hold about a gallon of liquid if it fits properly. I have been told that it is illegal to double brief in my state (IL), but I have no proof to back it up. I do know it is against my company's policy and at the very least will earn you a write up.

Star_Of_Life · Nov 9, 2017

I know this is an old topic, but I am a soon-to-be graduate nurse and would like to get some advice on this topic. I am gathering that the "typical" execution of double briefing is so that as one brief fills up, the other one can collect more? My previous experience is in emergency medicine, not LFT/ALF or hospitals so briefs and there related care are totally new to me. I was shown by a nurse at one particular facility that if you cut a hole just big enough for a male's "urethra and its associate appendage" (pardon the verbiage, I just don't want to upset moderators or readers) through that slit in the first brief, than as the patient urinates, it fills ONLY the second brief and there is no contact with skin. When you do hourly rounding, if the outer brief is wet, you change both. It is not by any means meant to put off a brief change, but rather work with the barrier cream to prevent maceration or infection.

So I'm just curious, given that scenario where ALL appropriate care measures are taken as they SHOULD be, is it still bad for the patient?

Been there,done that, ASN, RN · Nov 9, 2017

Double briefing is not an appropriate care measure. Get a Foley or a supra- pubic catheter order. You will not have enough time to check/ change your patient every hour. Trust me on this... they will be lying in their own urine for hours.

Welcome to nursing.

BBP42 · Nov 9, 2017

The last facility I worked in specifically forbid incontinence pads inside briefs as they told us these pads do not pull moisture in and away from the skin like the briefs we used supposedly did. It was a mandatory write up for the CNA if we found them in use. They tried purchasing extra absorbent overnight briefs for the heavy wetters and we did not find them any better, those people simply had to be checked more frequently.

CoffeeRTC, BSN, RN · Nov 9, 2017

Double briefing is not an appropriate care measure. Get a Foley or a supra- pubic catheter order. You will not have enough time to check/ change your patient every hour. Trust me on this... they will be lying in their own urine for hours.
Welcome to nursing.

A catheter for convenience is never going to happen. Nor should it.

CoffeeRTC, BSN, RN · Nov 9, 2017

I work in LTC, we recently had a rep from the company who makes the briefs we use come in and inservice our CNAs. If a brief is leaking and you feel like the resident needs to be double briefed, you are most likely using a size too big. A standard brief can hold about a gallon of liquid if it fits properly. I have been told that it is illegal to double brief in my state (IL), but I have no proof to back it up. I do know it is against my company's policy and at the very least will earn you a write up.

^^^ This^^^

You will not find it wrintten specifically "no double briefing" but it is a dignity and neglect tag.

We've had "heavy wetters" before and I've seen CNAs do different things...full double brief, brief with a women's incontinence pad, brief with wash cloths or folded towel.

Appropriate interventions might include a toileting or changing schedule that is resident specific or monitoring timing of fluid intake. Maybe that resident needs checked and changed hourly from 11pm to2 am? Maybe they need to increase fluids at breakfast and lunch and monitor intake after 9pm.

MrNurse(x2), ADN · Nov 9, 2017

I work in LTC, we recently had a rep from the company who makes the briefs we use come in and inservice our CNAs. If a brief is leaking and you feel like the resident needs to be double briefed, you are most likely using a size too big. A standard brief can hold about a gallon of liquid if it fits properly. I have been told that it is illegal to double brief in my state (IL), but I have no proof to back it up. I do know it is against my company's policy and at the very least will earn you a write up.

That is highly optimistic on that salesman's (that is truly what a rep is) product. I have personally tested briefs and have found the Abena's holding 3 quarts compared to Depends, a little over a quart. I go back and forth regarding T&P and changing Q2Hr. Patients need their sleep and 2 hours is too short to get a good REM cycle in, elongating to 3 hours may give better sleep outcomes, but the pressure thing is always there. Hard call.

Star_Of_Life · Nov 13, 2017

Double briefing is not an appropriate care measure. Get a Foley or a supra- pubic catheter order. You will not have enough time to check/ change your patient every hour. Trust me on this... they will be lying in their own urine for hours.
Welcome to nursing.

The problem with this is the risk for infection. An infection in the bladder/kidneys is far worse than some maceration of the sacrum. Hospitals don't want patients on indwelling catheters unless there is absolutely no other option. And even then, we are bladder training so we can d/c the catheter as soon as possible. Patients who get frequent indwelling catheters and CA-UTIs require frequent antibiotics. Antibiotics weaken the immune system, but also place them at risk of developing a drug or multi drug resistant infection.

According to the CDC, in 2011 UTIs were the third cause of HAIs at 93,300 for the year.

HAI Data and Statistics | HAI | CDC

Just to be clear, I am totally, 100% against neglecting patients and using double briefing as a means to put off brief changes. But the reason I was asking is because if the male appendage is placed THROUGH the first brief and ONLY fills the second brief, theoretically the first brief will act as a barrier between the patient and the urine. Once hourly rounding is done and it is noticed the patient is wet, both briefs are changed and supposedly the brief that actually touches the patient will be dry (in the absence of a bm).

If rounding is done correctly and the brief is changed when it's supposed to, the patient remains dry, no?

If, worst case scenario, the staff sucks and is neglectful and keeps putting it off and deserve immediate dismissal, the peritoneum is still dry and there's maceration on the thigh where the edge of the brief is, right? Because there is a plastic barrier on the bottom of each brief to act as a water proof barrier.

This is for MALES only, and again, not to be a horrible nurse, pct whatever. Just a means to prevent infection and maceration in conjunction with barrier cream AND regular changes.

applewhitern, BSN, RN · Nov 13, 2017

It takes an act of Congress to get a foley cath order at my hospital. They are a no-no, unless the patient has to have one for absolute accurate urine measurement. They are considered to be a major infection source, so our docs really don't like them.

applewhitern, BSN, RN · Nov 13, 2017

We don't even use briefs, we use diapers. Every patient gets 2 incontinent pads placed underneath them, then a diaper. This is a hospital, so we also use a draw sheet to pull patients with. Draw sheet, 2 disposable incontinent pads, diaper. Rarely have a problem with over-achievers (big wetters!)