help needed for my report/assignment

That's hard to answer without knowing what type of administration positions you have in your hospital. I would go to the Director of Nursing/Director of Care, Chief Clinical Officer, Infection Control Nurse, or any type of patient care director or something similar. Hope this helps.

I think any change in hospital policies would originate with the charge nurses/head nurses of those units that have these kinds of patients. There should be a "chain of command". If not, there should be some sort of suggestion box somewhere, or a means by which people can suggest change within the hospital.

Also, I believe that having a "policy" on how often patients are cleaned up can be disastrous. They should be cleaned when they are soiled. If that means every 10 minutes (thinking about maybe someone with diarrhea), then clean them every 10 minutes. If the "policy" says every 2 hours for example, there will be those nurses who check only every 2 hours.

In a hospital setting, I would think that checking them at least every hour is not unreasonable. How many times have you changed someone right before shift change, and then when the oncoming nurse goes to greet the patient, there is a wet diaper??

Maybe some of the diaper changes and cleaning could be delegated to a tech or assistant, but I wouldn't put that off on someone else all the time, because it's an excellent chance to check skin integrity (which, imo, needs to be done frequently on an incontinent patient). Other advantages of the nurse doing it are: checking for odor and concentration of the urine in the diaper, and checking for consistency of stools.

But back to your original question: I don't think the DON, especially of a large hospital, would be very amenable to hundreds of nurses flocking to her door with suggestions about patient care policy changes. BUT... if you really feel a policy needs to be changed, I think you should do a bit of research on what the policy should be, why yours should be changed, and present it in writing with references supporting your suggestion, to whoever is listed in the policy manual as the approving person or committee.

Changing policy in my experience usually is done by a team investigating all angles. This team would consist of all relavent parties including CNA, nurse, possibly coding (I believe medicare requires a certain standard), and administrative...possibly DON or ADON especially if this change in policy will require more hiring. All angles including paper work (documentation related to this change) will need to be assessed including JHACO/state compliancy.

Go read the policy, see who authored the policy (or what their title is) and talk to them.

Thanks everyone. sorry i wasn't specific as to what type of institution this applies to. I can see it might be different if it is a hospital or a nursing home. it is a report we are asked to do for school to check if we know who to approach in the event we want changes to happen which is why they probably did not specify the type of institution. as graduating students they want us to have an idea of the chain of command and who to approach in such a situation. although your answers varies at least I have some clues where to start. thanks.:)