Is this a new trend?

[hppygr8ful]

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

[heron, ASN, RN]

Ever see - or smell - the groin of a diabetic after days spent cooking in the moist, hot environment of briefs used atc? I'm not advocating for no briefs at all - although both of the refractory and painful breakdowns my facility resulted from around-the-clock briefs in spite of barrier creams. There are big dignity issues involved and should be respected.

I'm advocating for a real risk-benefit look at the question for each resident. And, yes, if a blanket rule has to be made, I vote for no briefs in bed. When we instituted this at my facility, we saw a dramatic decrease in skin issues, especially infections, as well as faster healing of existing wounds.

Of course, my facility is an LTC, exceptionally well staffed and we use very well-made re-usable incontinence pads.

[NamasteN]

This is actually a very old practice. In the 'olden days' there were no such thing as disposable depends. But this doesn't mean to not clean the patients. I have worked in LTC and in hospitals and I can tell you that no one ever takes responsibility. The nursing home says the hospital caused it and vice versa. I do know that in LTC that kind of excoriation is seen less. In my experience. That is why the LTC facility does a full body check when the client returns from a hospital visit, to document every inch of their body. No matter what the cause or who's to blame, the patient is the victim.

[NursesRmofun, ASN, RN]

Slight sidetrack here, but curious what you all have seen used as the best barriers to protect the skin whether briefs are used or not?

My favorites are:

Boudreaux's Butt Paste, or a DIY mix of Desitin + Nystatin + Maalox

And for extra protection, stoma powder, followed by no sting barrier spray, then topped off with either of the above creams.

To keep the expense down, I do like the moisture barrier creams with anti fungal and it comes in a generic no name brand. Never tried the stoma powder but haven't actually seen any ordered lately...just some pastes.

[NursesRmofun, ASN, RN]

Ever see - or smell - the groin of a diabetic after days spent cooking in the moist, hot environment of briefs used atc? I'm not advocating for no briefs at all - although both of the refractory and painful breakdowns my facility resulted from around-the-clock briefs in spite of barrier creams. There are big dignity issues involved and should be respected.

I'm advocating for a real risk-benefit look at the question for each resident. And, yes, if a blanket rule has to be made, I vote for no briefs in bed. When we instituted this at my facility, we saw a dramatic decrease in skin issues, especially infections, as well as faster healing of existing wounds.

Of course, my facility is an LTC, exceptionally well staffed and we use very well-made re-usable incontinence pads.

I agree it has to be looked at some more. The facilities I have seen lately are still using the briefs. I don't think they have a large amt. of breakdown, but there are some cases. I don't think the residents mind the briefs or are not mentally able to state if they care about them or not. They are definitely not well-staffed facilities....and they are usually low on some items, hard to get good products. They do have good pads but sometimes not washed in a timely way...so none available.

[heron, ASN, RN]

As I noted, my facility is unusual in that supplies are available and pads are laundered daily - we have an in-house laundry.

The majority of our residents are incontinent, but we have enough staff at night to change them timely. All inc. residents wear briefs or pull-ups when out of bed and that's where a lot of problems started when they were up all day. Some were going from before breakfast until after supper in the same brief. Their dementia made it impossible for them to ask to be changed. Orders had to be written for them to lay down after lunch and no briefs in bed before we could get a handle on their skin issues.

[martymoose, BSN, RN]

but we have enough staff at night to change them timely.

Ding ding ding! we have a winner!

I think this is the bigger factor.

No one would be left IN a wet brief if they were attended to in a timely manner in the first place.

Poor lasix pts....

[mvm2]

For goodness sakes it is not the briefs fault for these skin issues if a place allows people to wear a brief for 10 hours without a change. That is neglect on the facilities part. The breakdowns are due to human negligence not because they wore briefs.

Any facility should be ashamed of themselves not only letting people stay in a brief for that long of time but also blaming the dementia resident for not asking to have it changed.

People can have briefs on and not cause skin problems if they are changed in a timely manner!! My mother in law had terrible incontinence problems and she wore a brief with three thick poise pads night and day and not once did she have skin breakdown. Briefs are not the problem... sitting in wet or poop filled briefs for too long is the problem.

If people want to lay in bed without briefs that if fine.. but if someone wants a brief on they should be able to wear one. No one should have to be forced to lay and sleep naked because that is what a facility wants