Patient Bathing...or Not.

[LobotRN, BSN, RN]

How do we get it done?

I am looking for ideas on how to address patient hygiene issues in acute care. It is essential nursing care in my book, I am all for it, I try my best to get it done and help our CNAs to get it done. I'll absolutely MAKE it happen if a patient is exceptionally fragrant. But it doesn't always happen, and now it is on the "list" of high priorities for patient satisfaction for our managers. So frustrating.....

1. We often are not staffed to matrix. So when we do not have a unit clerk, the phone traffic becomes another nursing responsibility. I can either answer the phone which could be a critical lab value, physician, or family member, or I can let it ring ring ring and then hang up while giving a bed bath. Bathing is even less likely when we are down one nurse or one CNA.

2. We allow very few people out of bed on their own, so just letting them "have a shower" is not an option for 85% or more of our patients. And I don't like the idea of letting any elder bathe solo on a wet, soapy, slippery surface, even with a shower chair. If you're younger, I might risk it but certainly don't breathe a sigh until you are out and dry!

3. We don't have a "system" for determining who is due...if you are here for surgical observation and won't be here more than a day, are we to offer a shower in that case? On the other hand, we don't have a shower schedule for those patients who may be with us for 3 or more days.

4. Bathing for most of our patient population is at least a 30 minute affair....covering IVs and dressing sites, finding shower chairs and supplies.

4. Can I just have a bathing team? Kind of like a lifting team? Oh wait, we don't have that either....

Is anyone successfully providing hygiene in the hospital? How are you doing it?

[hppygr8ful, ASN, RN, EMT-I]

The idea of a bathing team is unique and interesting but also kind of like a flying pig. I work in LTC so we do have a bathing schedule and patients due to fragile skin issues only get a full bath/shower evert 3 days. with sponge bath the other days. I would suggest that your staff be a but more organized having hygiene supplies, shower chairs, etc ready to go before bath time. It's laudable that you want to help with bathing but as an RN I rarely have time to perform this function except with residents who have a skin issue or wound that I need to see or dress. In that case I try to coordinate with the CNA staff so we can coordinate care and save time.

hppy

[ArmaniX, MSN, APRN]

Does your hospital offer bath wipes?

In the ICU every patient gets a CHG "bath" nightly. It has become night shifts responsibility. So every night CHG bath and new linen.

I do not find it realistic to get every patient up and into the actual shower, this is acute care not LTC/rehab correct?

I feel patients should have their linens changed daily at the minimum. Perhaps to divide the work you could have something such as all EVEN rooms get bathed at night (ODDS during the day)?

Further more if these are competent patients they can be asked if they'd like to be cleaned up. Not everyone always does.

[flyersfan88]

Competent patients get asked. If they don't want to....whatever. Our night and day CNAs divide who will get done at night/in the morning. Works pretty well.

[nynursey_]

Large, Level 1, acute care RN here. My perspective:

If a patient is AAOx3 and independent, they are asked if they'd like to take a shower today. If they say yes, I make it a point to schedule them in the shower rotation with the PCA. If they say no, I ask if they'd like a wash basin and some supplies to do a partial bath. If they say no, then I chart accordingly: "patient refused AM care." An alert and oriented person completely has the right to refuse. It is, after all, a patient right. I follow the same process for bed-bound or patients who are not ordered ambulation, but rather bed rest. I offer a bed bath and if the patient declines, I chart accordingly. If the patient can assist, I then set them up to assist the parts they are able to clean themselves, and then return with the PCA, or delegate if possible, and help finish the rest.

On total care patients, or patients with dementia, or patients who are non-verbal with communication barriers, I explain the importance of a bed bath, and explain that myself and the PCA will assist to get them washed up. Then I perform a full bed bath. Utilizing 2 persons, while often difficult to do, makes the process that much quicker.

As per my facility's policy, linen changes are performed every other day unless a patient specifically requests to have their bed changed, and/or it is soiled.

You really do have to look at your patient, as well. Full baths/showers are not always indicated QD for each and every patient, especially depending on their admitting dx and recent procedures.

I do agree scheduling can be tricky, but good team work and delegation should help, especially if you have management out of rotation, like an ANM or Nurse Clinician.

[NurseStorm, BSN, RN]

Mark on the kardex the date of their last bath. Then at least you know. You don't have to have a "schedule" per say, but you will have an easier time picking priority. Bath yesterday? They are probably okay. Uh oh Mr Johnson hasn't had a bath for 4 days we better make sure he gets one.. etc. I work peds/maternity so this isn't the same type of issue here. It is quite an ordeal to get a c-section mom up to the shower for the first time, but it needs to be done so it's just built into your day.

When I was a student in long term, everyone got at least a partial bed bath daily before being helped/lifted out of bed. And there was a schedule for full baths that was followed. I don't understand why they aren't getting done, that should be one of the main tasks for the CNAs should it not? (We don't have CNA's so I don't know really their role). As part of the process of starting the day it should be expected everyone gets at least a partial bed bath (face, underarms, back, bottom, peri area at a minimum imo). Could this be discussed at a staff meeting if it's such a unit wide issue?

[dream'n, BSN, RN]

Baths? I work acute care 12 hour shifts, that generally turn into 14 hour shifts. There is NO time for me to worry about or give a bath unless my patient has a Central Line or a pre-op chloro. wash. Heck, I haven't given a total bath or seen a Kardex since nursing school.

[NOADLS]

The "or not" option seems to be the answer.

It requires you to do less work. And... you get paid exactly the same amount!

[blondy2061h, MSN, RN]

Our patients also do chlorahexadine wipes. Our walkie talkie patients do them by themselves. It takes about 10 minutes to do it with a bed bound patient. A chairbound patient I'll make do their own chest, abdomen, and arms while I do their back and legs. Give them a soapie wash cloth for their face and hands and you're set.

[hppygr8ful, ASN, RN, EMT-I]

Our patients also do chlorahexadine wipes. Our walkie talkie patients do them by themselves. It takes about 10 minutes to do it with a bed bound patient. A chairbound patient I'll make do their own chest, abdomen, and arms while I do their back and legs. Give them a soapie wash cloth for their face and hands and you're set.

I hate chlorahexadine wipes. Aggressive disinfection is the birthplace of Multi-drug resistant organisms.

A good bed bath with plain soap and water is the ticket.

Hppy

[OnlinePersona, LPN]

Our patients also do chlorahexadine wipes. Our walkie talkie patients do them by themselves. It takes about 10 minutes to do it with a bed bound patient. A chairbound patient I'll make do their own chest, abdomen, and arms while I do their back and legs. Give them a soapie wash cloth for their face and hands and you're set.

Ya that's what we do in our ICU

[blondy2061h, MSN, RN]

I hate chlorahexadine wipes. Aggressive disinfection is the birthplace of Multi-drug resistant organisms.

A good bed bath with plain soap and water is the ticket.

Hppy

We weren't doing them for ages. Just went back to them. Our CAUTI and CLABSI rates have gone way down with them. It's literally against policy to do any other type of bed bath now. Our ICU and neutropenic patient populations get chlorahexadine, while our regular floor patient population uses non-disinfectant bathing wipes.