Non-diapering nursing home patients

[ASSEDO]

My Mom was transferred from an inpatient rehab facility to a nursing home with skilled rehab. She has incontinence, but I was very shocked the nursing home facility has a non-diapering policy, so Mom urinates on a cotton pad on the bed. The nurse said it cut down on diaper rashes, fungus, and skin breakdown. I realize that some air exposure is good. They put on adult diapers only when the patient get up in a wheel chair. The nurse explained that policy was in place at another local nursing home. Is this a quality of care issue? Where is the research? I failed to find it. Thanks

[Nascar nurse, ASN, RN]

This is actually a pretty common practice (although I never really bought into the theory). I was Director of Nursing at a facility that this was corporate policy through out their entire chain of facilities. I've worked with other corporations that did not have this policy. There was no difference in the frequency of incontinence related dermatitis between the two.

If this makes you or your Mom uncomfortable, just let the unit manager or DON know that it is your expressed preference that Mom be allowed to keep an incontinent brief in place at all times. They should careplan that as a preference and follow thru from there.

[amoLucia]

I too have worked at places that left the residents 'open to the air' at bedtime. I didn't care for it either.

Express your concerns & wishes to the management or care conference team.

[CapeCodMermaid, RN]

We don't put briefs on residents at night unless they ask. I've worked in many facilities and this is usually the policy.

[VivaLasViejas, ASN, RN]

No human's bottom was meant to be encased in plastic 24 hours a day. Leaving the area open to air while the resident is in bed is usually better for their skin, as long as they are checked for incontinence routinely and changed as needed. However, it can be a dignity issue for some folks and personal preferences should be honored if at all possible.

[sbostonRN]

We don't even stock the incontinence briefs at my hospital. If a patient wants them, they have to bring their own but we don't condone their usage. We'd rather have them go on the bed pad and then change it than walk around with half a days worth of urine in a diaper and get skin breakdown. I don't know what the research says but this is a magnet facility.

[CapeCodMermaid, RN]

Hospitals are far different from SNFs. We have residents who are totally incontinent. They do not remember what a toilet is for. It is not feasible to toilet every resident every 2 hours in an attempt to keep them dry. Wearing a brief is far more dignified than walking around with wet pants.

Your patients who are 'walking around' should use the toilet and not a bed pan to more thoroughly empty their bladder. And, if your patients are 'walking around with half a day's worth of urine in a diaper', that is a staff issue and sounds like neglect.

[CT Pixie, BSN, RN]

I've worked in facilities that do both. This is just my observation but those who only used a pad overnight did tend to have more 'rashes' on their bottoms.

When the pads are used, if the person cannot move they are sitting on that wet spot until next rounds are done. Rounds are generally done every 1 1/2-2 hrs. So that person could be in that moisture for 2 hrs. At least with the briefs, the moisture is wicked away from the skin.

I agree with Viva that the skin should be allowed to be open to air, leaving it open to air as it sits in wetness is no good either.

I personally liked the facilities that used briefs.

[systoly]

i believe it is a quality of care issue, if the patient's needs are not evaluated and

addressed on an individual basis, but rather on a one size fits all policy

the reason you were given for not applying briefs while in bed has validity, and it is

backed by research (which you can find on this board)th

there are also other reasons for such a policy which are not as liberally disclose

bed pads come in one size and are less costly than briefs

briefs not only cost more per unit, but also require more storage space and inventory

making pads a lot more economical

while that may sound bad, there's nothing wrong with being frugal about the use of

supplies, after all, we use generig drugs when we can for the sole purpose of saving $

[systoly]

continued

there are situation and patients that are ill served by a no brief policy

has your mom ever had any problems with rashes fungal infections or skin breakdown?

does she feel insecure about not wearing briefs?

do pads adequatetly address her voiding pattern?

does she toilet herself or with assistance, but suffers from stress incontinence?

those are some of the concerns that need to be addressed and a global policy

cannot do this

[Sassy5d]

Cost is a huge issue.. BUT, what would you prefer??

I, personally, would much rather have incontinence in a brief than have it soak up a pad under me. Sit in a soggy brief that's pretty much contained or lay on a chux?

[ASSEDO]

The facility could not point me in the direction of scientific research to determine if air exposure non-briefs) vs urinating on a bed pads make a difference. My Mom wore briefs years before her stroke and never had an infection or skin breakdown, but she cleaned herself often. Maybe if the facility does peri-care ever two hours, she will not suffer from tissue breakdown. I have ordered her night time briefs, so maybe that will work. It's ashamed families can't have a "Grannie Cam" to monitor the elderly like some day care centers.