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Is this a new trend?

Posted

Specializes in Psych, Addictions, SOL (Student of Life). Has 19 years experience.

A local hospital has been sending us residents with severe diaper dermatitis - I mean deep red excorriation so bad that the redisident in one case was bleeding. When I spoke to a family member I was told the nurses at the hospital did not use disposable briefs but instead put bath blankets of towels between the patient's legs and actually told the patients to go ahead and pee in their beds and they would clean them up after. But patients are sitting in their own waste.

When we called the hospital with the client/family complaint they denied the practice and said the parient had clear skin when they were discharged. There was a meeting with the CEO of the hospital today to discuss this problem.

I am just wondering if this a new practice I haven't heard of.

hppy

Red Kryptonite

Specializes in hospice. Has 3 years experience.

With the wisdom of some of the cost cutting decisions I've seen, I wouldn't put it past them, but I sure hope this isn't a new trend.

Farawyn

Has 25 years experience.

No, it's not. I've also seen towels wrapped in a diaper and taped. Horrible breakdown.

flyersfan88

Specializes in Trauma, Orthopedics.

Reminds me of the anti-bedpan post going on a few weeks ago.

This is not new practice. This is, however, awful/lazy practice.

ahorton75

Has 1 years experience.

In my major hospital system, we are no longer allowed to use briefs. We are to use bed pans or bed side commodes. For our incontinent patients we use a towel and a chuck.

The reasoning is that briefs hold moisture and lead to skin breakdown. With no brief, it is believed that the stool or urine will be caught sooner and taken care of quicker.

With the new types of briefs available, they do not hold moisture next to skin. It is wicked and held in gel form...much like Pampers for babies.

Using a towel is just going to contribute to moisture and dermatitis breakdown, unless you stand there and change it immediately. I know that you, nor anyone else, has the time to accomplish that.

Though i agree on bed pans and commodes being used i do not agree on people being exposed or just having to eliminate on chucks and towels. Briefs if changed q2 and person is cleaned up properly will not cause that many skin breakdowns. No more then a diaper on an infant's bottom. We seem to think this is acceptable but not on an adult. Talk about dignity issues. I am not understanding the thinking behind being caught quicker if using towel. As many times as you would change a towel you change the brief instead

Is barrier cream or ointment used?

Examples: Calmoseptine, A & D, Zinc Oxide, Desitin

hppygr8ful, ASN, RN, EMT-I

Specializes in Psych, Addictions, SOL (Student of Life). Has 19 years experience.

Is barrier cream or ointment used?

Examples: Calmoseptine, A & D, Zinc Oxide, Desitin

Once we get them yes but you know how rough an industrial terry cloth towel is -it's like san paper on tender old skin when they arrive it does not appear that any barrier cream has been used.

hppy

Coming from home health perspective, Depends type briefs are commonly worn voluntarily, whether or not they try to make to urinal or toilet first. The bedfast, usually with a single caregiver at a time, do most often wear adult diapers.

If changed timely and skin barriers are used we either avoid or resolve incontinence related breakdown and as far as dignity, that's been their choice.

I don't know where it came from that those products strip their dignity.

MunoRN, RN

Specializes in Critical Care. Has 10 years experience.

As threads here have shown, avoiding the use of briefs in hospitalized patients is actually becoming somewhat common, the reason being that incontinence should be managed with immediate clean-up and pan or linen changing and the use of a brief is often just an excuse not to do that. Generally dermatitis is more closely related to the use of briefs, not the lack of briefs.

Unfortunately, even when incontinence is made harder to ignore by not using a brief the laws of time still come into play. With the acuity relative to staffing that now exists in hospitals patient don't always get cleaned up as soon as they should.

RNperdiem, RN

Has 14 years experience.

I wonder if the towel trick is a work-around nurses used when briefs were eliminated. Instead of prompt clean up of the chux with good skin care, which eliminating briefs were supposed to do, nurses made things worse by using towels instead. The patients would have been better off in briefs which at least are more absorbent.

My hospital went to great lengths to educate staff on the newest policies on skin care, virtually eliminated briefs and has policies on how much linen can be used under a patient. I work in ICU, and skin breakdown and excoriation is a big risk that we take seriously.

CelticGoddess, BSN, RN

Specializes in Palliative, Onc, Med-Surg, Home Hospice. Has 6 years experience.

In my major hospital system, we are no longer allowed to use briefs. We are to use bed pans or bed side commodes. For our incontinent patients we use a towel and a chuck.

The reasoning is that briefs hold moisture and lead to skin breakdown. With no brief, it is believed that the stool or urine will be caught sooner and taken care of quicker.

We aren't allowed to use briefs either, however, we are using covidien pads. WE are allowed to use a newborn diaper (it covers the penis, to prevent the entire bed from getting soaked) but it can't be wrapped, only placed. I like the covidien pads because they are strong (we can move a patient in the bed with them) and if we can't get to them immediately (say we have code) the pad keeps them dry until we can get them cleaned up. I can only speak for my unit and my shift, but we are very good about changing patients quickly. We have a good record for no skin breakdown (and we have quite a few long termers on our unit)

Unfortunately, I have seen residents coming from certain LTC facilities who have horrid breakdown, and it wouldn't surprise me if they wrap towels/chucks or multiple briefs so they don't have to change their residents as often.

whichone'spink, BSN, RN

Has 3 years experience.

This is definitely not a trend in the two hospitals I have worked in.

NursesRmofun, ASN, RN

Specializes in Registered Nurse.

In my major hospital system, we are no longer allowed to use briefs. We are to use bed pans or bed side commodes. For our incontinent patients we use a towel and a chuck.

The reasoning is that briefs hold moisture and lead to skin breakdown. With no brief, it is believed that the stool or urine will be caught sooner and taken care of quicker.

I guess this explains the problem. Had not heard of this until just now. I think it's a very bad idea. How is it working in your hospital?

mmc51264, ADN, BSN, MSN, RN

Specializes in orthopedic; Informatics, diabetes. Has 9 years experience.

In acute care, we get pts that are not happy that we won't let them wear their briefs. We emphasize that we would rather clean them frequently than let them sit in a soiled garment. usually it takes a little while for them to believe this. The situation described by OP is horrid. That is neglect. This is also we photograph any skin irregularities upon admission.

Here.I.Stand, BSN, RN

Specializes in SICU, trauma, neuro. Has 16 years experience.

Ooohh...wet terrycloth on fragile skin sounds like a recipe for breakdown. I used cloth diapers with my babies for a while; my youngest had such sensitive skin that I had to switch to disposables w/ barrier cream because he was getting blisters even w/ q 1 hr diaper changes. Like a PP mentioned, the absorbent material in disposables wicks moisture from the skin and turNS it into a gel, whereas wet cloth keeps the skin wet. Plus terrycloth is so bumpy. Sit on a towel for two hours--you're going to have an impression on your bum.

My hospital discourages briefs too, but we have disposable Chux which are smooth and are supposed to allow for air flow.

xoemmylouox, ASN, RN

Has 13 years experience.

I suppose I get the "idea" of eliminating briefs, but using scratchy towels is not the answer. How about having resonable staffing and absorbent pads? I suppose I don't have the answer, but I do know those awful towels are not it.