incontinent NH pts

Trauma Columnist · Jul 9, 2009

Chronic HD is an outpt environment - IMHO the incont NH pts should be handled by NH personnel. That said, in our large (32 chair) HDU there is no way to ensure any type of privacy if we needed to change a pt. We require the NH staff to come and change the pt. If the pt is habitually incont - they should come with diapers and/or a change of clothes and a sitter that can attend to their nees.

GeauxNursing · Jul 12, 2009

we don't change pts in our clinic either. there isn't time nor enough staff to do it. One lady always had to go as soon as the ambulance guys had just put her in the chair and left. As long as she was able to assist somewhat we would try to accomodate. But once she became "chairbound" and lost her muscle tone we just couldn't. 3 ppl had to come help, it was a 30+ minute ordeal, and that left no coverage on the floor during turnaround.

Our NH pts never even come with anything to change into in case of accident. So if there is one, there is nothing I can do. We don't stock briefs for pts. What would we do? Use our crappy paper towels to clean them up in the mddle of the floor? Put a chuck in between their legs? No privacy, no clean briefs.

I feel bad saying it, but that is what a brief is for. Accidents. Sorry if I offend anyone. I don't feel it's my job to clean up incont. pts. Or to try and assist in lifting a 170lb lady onto the toilet and holding her there because she can't hold herself.

**canoehead, BSN, RN** · Jul 12, 2009

Wonderful. Would you give CPR if they died, or are you too poorly staffed?

GeauxNursing · Jul 12, 2009

if they died, isn't CPR pointless?

these are 2 completely different situations.

3cdn1usa · Jul 12, 2009

I have worked at a few units that CMS was called and investigated the situation. Part of the POC was to clean the pt and the NH to sent clothes and attends everytime they went to HD. Of course no one wants to do it, I do agree there is no privacy and we are also dealing with pts being very close to each other (these units also have nocturnal so there are beds) and access' being accessed. Best to take care of these pts as you would want to be treated as we all do not know what situation we may be in the future. I would hope that someone will take care of me that way.

GeauxNursing · Jul 12, 2009

Well now I've gone and made myself sound like a heartless soul, right? Not my intention. Luckily, I have never refused to change someone, I understand that it must be an awful feeling for someone to feel. I've helped to take someone to the restroom who can't hold themselves up and can't wipe themselves and needs to be physically supported (by 3 of us) for 20 minutes while trying to go. It sucks. I know it must suck to have to go and not be able to as well. But what about losing 45 minutes of your treatment due to having to go? Being taken off, getting extra NS, being hoisted and huffed and lifted and slid and made to feel worse just to get on the toilet?

I'll stop. I guess there is no way to agree on this one. I know that I would want to be changed, too.

Going back and thinking about it, I've gone about this response all wrong. I have never refused to take someone to the restroom. I make 10000% sure that they really have to go before I start the process of rinseback, taping down lines, etc. I make sure I get help to lift them.

I guess my original response was thinking back to the nightmares of that poor lady who always called on us to take her at the worst moment, then she ended up doing nothing after a 30-minute struggle. Whether she just wanted attention or what, it definitely was a pain in the neck. Every single time. And it hurt so much because she was so sweet but by the end she was so miserable and just wanted to end it but her daughter wasn't ready to let go. This whole situation made us miserable, too. Just bad for everyone.

I guess what I should have originally said was that I have never refused a changing or a trip to the potty. I have never had to change someone out on the floor. If it came to that, I would no doubt do what I had to do. I could never knowingly allow someone to lie helpless in feces. I am not one for making someone suffer or feel embarrassed over something uncontrollable. Everyone uses the bathroom. No one should be forced to sit dirty for 4 hours. That opens the whole decubitus can 'o worms.

If it was my nanny in a dialysis chair, you can bet I'd be calling CMS if I found out she wasn't being treated humanely.

My apologies for offending anyone.

Trauma Columnist · Jul 13, 2009

I didn't take your answer as offensive. I round on pts in 15 units ranging from 6 chairs to 32. The lack of privacy and inability to care for a pt in the outpt HDU environment has led to withdrawal from dialysis for several of my pts. Outpt dialysis's goal is to improve quality of life, not be their entire life. We have a couple of nursing homes that do dialysis in the nursing home. That is probably a better environment for someone who is chronically incontinent. They can then maintain their dignity but also receive dialysis.

pricklypear · Jul 13, 2009

Wonderful. Would you give CPR if they died, or are you too poorly staffed?

Kind of an unnecessary comment. Have you ever worked in an outpatient HD unit? If you had, you would understand the frustration of having an incontinent patient in a RECLINER who probably cannot stand or be repositioned without several people, poop everywhere, no privacy curtains or nice little bath buckets with hot soapy water. Alarms, turnaround, patients wanting this and that, docs on the phone, BPs in the toilet all around the room. It's not really that HD units are "poorly" staffed, we are just not staffed for that kind of treatment on a regular basis. Having someone be incontinent on the ED gurney with supplies and help convienently nearby is a different story.

Onekidneynurse · Jul 13, 2009

Yes, in an outpatient unit I worked in the NH would give suppositories on HD days. We found them in the feces. And as others have said it's very difficult to turn and clean a patient in a recliner.

traveler RN · Jul 14, 2009

I am tired of NH pts coming in with poop when they know they will be returning to them for the care they should have gotten. Sending extra diapers is futile when they need more care then what we can give them. When we call to say the person is being returned they act shocked. My day is early and long with calloffs, meds, supervision, sudden temps, MD"S, Rx refills, med reviews, assessments, foot checks, pt teaching. Oh dont forget the blood and vomit that just got on the floor, the wrong dialyzer, bath or needles and did anyone get that phone!

81Bubbles, BSN, RN · Jul 15, 2009

THe chronic unit I worked at it was Against policy to change a pt's soiled brief during HD. Do to infection control you were to try and keep it cointanied.

If someone needed to come off to use the restroom we did that but unless there was "a complete diarrhea storm" that was seeping out of the brief we did not change them ever.