Double padding, what's the nurse to do

[Sn0wflakeRN]

I have been a nurse for 5 1/2 months and I've been employed in an LTC for 6 months first as a GN and now as a RN. I work 6-2 shift and we have a few "bad egg" cnas on night shift that like to double pad, triple pad. Hell, I had a resident that had 3 bed pads and 2 draw sheets under him. Other than writing the cna up and since she had already left, the day shift aides had to fix it. Do I chart on it or no?

[Mn nurse 22]

Do a thorough skin assessment immediately and chart your results, and ask your management team, some places will want an incident report and a VA report, other places might want to sweep it under the carpet. If the ski assessment shows the patient has red skin, breakdown that is a whole separate issue.

[Sn0wflakeRN]

Several of those that were left like that already have break down and yeast. The night nurse whose shift that it happened on yelled at me for charting that illegal activity happened. I was just trying to cover my behind.

[amoLucia]

NO.

It's NOT something that I would chart as "double padding" in the chart. Yes for the redness found and the interventions that you did and update the care plan.

But I would do an incident report (DO NOT write 'incident report' in chart either!). And you could start a disciplinary write-up. CNAs do know that double padding is NOT permitted and against the rules. They're being lazy and they risk pts' skin integrity. So an incident report and the disciplinary process are appropriate. And the nite nurse now knows that she must supervise her aides or else she's just as wrong as they are. Make sure that your UM or supervisor knows also.

A paper trail is needed and this esp crucial if she is UNION. YOU need to go thru the chain of command so all the right steps are taken in the right sequence as well as the paperwork. But the chart is NOT the way to do it.

[HouTx, BSN, MSN, EdD]

I would recommend a bit of additional investigation to find out which CNAs are doing this so you can target an effective intervention rather than using a heavy hand that could only make things worse. After you find out who the culprits are, you will want to explore:

* What is the motivation behind this behavior?

* Do the CNAs understand why it is a 'bad' thing to do?

* Do they know that it is a 'rule violation" (policy & procedure)

Next step is one of two options, depending upon what you have discovered

Option 1: for anyone who did not know the 'rules' or didn't realize/forgot the bad things that could happen to the patient.... make sure that they know exactly what the rules are & let them know that the next time they do it, they will be punished (suspended, terminated, etc)

Option 2: for anyone who knew the rules & potential for bad outcomes .... take punitive actions because they deliberately chose to this "risky behavior"

This approach usually works, but keep an eye on this issue, because "drift" happens... staff gradually start to cut corners if the rule is not re-emphasized regularly

[morte, LPN, LVN]

double diapering I understand the problem, if they simply have 2 pads under them....what problems are you thinking about? I always thought it was simply not done because it was a waste of linen. again, not diaper, skin is open to air. we thinking along "wrinkles" causing pressure areas? is this a person who moves/slides down in the bed?