Has anyone heard of this shortcut?

[newtress]

Hi all, I just finished my LPN geriatric clinical. I was curious to know if anyone who has done clinicals has seen this "shortcut", what it does and why. I was finishing a bed bath on a resident and had a time changing out a disposable diaper. After placing the diaper in the proper position to roll resident back onto the diaper, the CNA assisting me placed a generous amount of skin lotion in a verticle line in the center of the diaper and said it was a shortcut. There was no explaination why this was done or what it does for an incontinent resident. Ease of removal for next change? Easier clean up? Skin protection? I absolutely do not know what could have been the reason for the lotion on the diaper. Anyone seen this done or know a reason why?

[Daytonite, BSN, RN]

this is part of the challenge of working in ltc with cnas. don't ever apologize for doing what is for the safety of a patient you don't know as well as these cnas. believe me, if a patient fell out of the bed, there would be some explaining to do. a patient climbing over the side rails and breaking a hip compared to a nurse failing to raise a side rail and the patient falling out of bed and breaking a hip is interpreted a whole lot differently by the safety committee that reviews the incident report. how in the blazes is an unfamiliar nurse going to be blamed for a patient climbing over the side rails of a bed? she's sure gonna take heat for not raising the side rails though. just keep doing what your instructor has taught you. if the facility has problems with student nurses raising the side rails of the patient beds, they will pass it along to your instructor. however, i'm betting that she's not going to hear diddley squat on this. i've worked in ltc off and on over my career and i am very familiar with the rules on restraining patients and strategies to prevent falls. and, if you choose to work in ltc after you graduate and get your license you will learn them too. until you are the one in charge and can make a decision about siderails being up or down on the patients under your charge, you always stick with basics.

fyi. . .years ago i had a patient in the acute hospital who managed to scoot to the foot of her hospital bed and get the bottom end of her side rail down, climb out of the bed, and promptly fall on the floor and break not one but both hips. she never called out for help, never said a word. we found her like this when we made rounds coming out of change of shift report. worried about the legal problems that might come up, i wrote a page and a half on her chart. i also drew a picture of the scene in the nurses notes that showed the position of the side rails as i found them and a stick figure of the patient as i found her positioned on the floor by the bed. i never got so much as a call from anyone in administration or nursing on the incident. i was sure there was going to be a lawsuit with two broken hips. if there was any kind of legal action, i never knew about it. after that incident i started including notations about the position of the side rails in all my charting from then on. i worked with one lpn who had to give a deposition on a case of a fall from the bed where a patient broke his hip. the whole problem the hospital was having in defending itself was that no one had charted that the side rails had been pulled up. nurse after nurse claimed they had pulled his side rails up, but no one had charted it--and that was part of the hospital's problem with the lawsuit. my whole career i've spent a lot of extra time charting things like that which some people might think were a waste of time. i assess everything i can think of and chart on it all. i'm always thinking about the "what ifs".

[caliotter3]

Concerning the bed rails, as a CNA working in LTC, I was perplexed one time when we were told that the rules had changed about side rails. I was taught that side rails were to be up for safety, unless an exception was signed off. Then, when we were getting ready for our yearly survey, an advisor changed the rule, stating that the reason was that "now it is considered an unauthorized restraint". Now there had to be documented exception orders to have the rails up for the residents.

[morte, LPN, LVN]

Concerning the bed rails, as a CNA working in LTC, I was perplexed one time when we were told that the rules had changed about side rails. I was taught that side rails were to be up for safety, unless an exception was signed off. Then, when we were getting ready for our yearly survey, an advisor changed the rule, stating that the reason was that "now it is considered an unauthorized restraint". Now there had to be documented exception orders to have the rails up for the residents.

yup, no siderails in long term care in both state i work in, if you dont have a specific order.....considered a restraint....when this first went thru....about 7-8 years ago...worked at a home one noc, there was a new admission...that was the day that state went thru and said "NO MORE SIDERAILS"..... so the home took them off the beds...went back that noc, that new patient rolled out of bed, head her forehead...requiring ~13 stitches in what was left.....