Scheduled toileting not being done by certain CNAs

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Our facility got deficiencies earlier for our incontinence program, which I corrected with new forms etc. The staff was very gung ho about the new program at first. But now I suspect that not all the CNAs are following the schedule for toileting certain residents. Any ideas how I can follow up on them other than me or the charge nurse following them around all day to ensure it is done? I figure if they had a check off sheet, that they could just write it was done without actually toileting the resident, but I am so busy I would like some ideas that would not be too time consuming. What do you all do in your facilities? Any help would be appreciated!

Trust me we didn't like doing this, but things were out of control. The union was aware of this and it was used constructively. I/ we don't mind that turns are not being done on the excact minute of the hr. Its just when a CNA would tell you, I just turned/ changed Mrs so and so and you knew they weren't changed or turned (because you did it yourself) and they might have documented that they did...............Trust me, I am always on my CNAs side. I only have a few expectations and unfortunatly over the years they've gotten less.

First off....tell me the truth,we are all adults and deserve to treat each other with respect, there is never a stupid question, always ask for help, ask me for help and, my biggest....We are here for the pts.

When I am lied to my face, its very insulting.

As far as the vital incident, it was very interesting when a the staff would always ask for yesterdays list of vitals,or when the equiptment never left the desk or my cart, or when residents complain no one ever takse their temps,etc. We decided to lock the stuff up....when only a few people asked for it, but all vitals were charted.........Trust me, we didn't use it to embarass the staff, I took them aside and asked them Why... a few needed reteaching and the rest just didn't care.

All of these things were going on while staff always had the 10-15 minutes 5 or six times a shift to take breaks and or smoke (and I don't mean thier scheduled breaks)

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Specializes in LTC, ER, ICU, Psych, Med-surg...etc....

Does anybody really pee every two hours?? hehe:chuckle

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Specializes in LTC, assisted living, home-care.

OH YES... I am a CNA in longterm care facility on 11-7... We are responsible to check, toilet, and change/turn our residents. Q2...WE DO because of our shift having the time and staff to do it... I could not work the other shifts because of the "overload" and short staffing. I applaude the marking of the briefs... In out facility, we have had sheets marked because family has complained of not being clean, basins marked because of residents not being clean, and briefs counted and marked because of incontenience of residents for HOURS... The work got done when people KNOW others are watching and the Cig breaks turned back to the 15 min instead of 20-25mins... My motto is if you are looking over your back for management to be watching you, DO IT RIGHT AND YOU HAVE NOTHING TO BE LOOKING FOR...

I have only been in nsg for 2 years now and I am "over the hill" past 50YR Old, so maybe I can have more compassion for my residents than other CNAs young and enjoying the transisition from CNA to LPN or RN.... Someday they will not have to change and reposition, but it is still their responsibility to see it gets done ....My hats go off to ALL THE NURSING STAFF... Right down to the housekeepers, laundry and dietary.... Work together and do it right the first time..... We may all be in our residents beds some day.....Huggs

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Specializes in Mostly ETC, very interested in wounds.

well i have to put in my 2 cents and tell everyone that my facility has always had the patient's attends or any other type of pad signed and dated by the cna in charge of that person for the shift. inc pads are changed every 2 hours and pads for occassional dribbling or pull ups are changed at least once a shift and that's the final rule. sure some times we are called harsh but the work has to be done. also if you are caught charting something that you didn't do. it's called fasification of documentation. the cna's charting is part of the medical record and is legal in the court of law.

if a cna is noted not doing there job they are immediatly disciplined to try to correct any bad behaviors.

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Does anybody really pee every two hours?? hehe:chuckle

I have to agree. The regs may be specific but I don't think anyone would find a pattern with me. When we have done the bladder diaries to try to find a pattern we discovered that the staff just filled in the paperwork!. Nothing made sense. We are struggling to work with the regs but have failed miserably.

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Specializes in LTC, assisted living, home-care.
Does anybody really pee every two hours?? hehe:chuckle

Yes, and we record the "Check, Turn and Reposition Q 2" That means WE CHECK and Change PRN....as well as turn/reposition (schedule, back, right, door, window, door, back etc.) according to schedule of faculity... A good many of OUR residents are incont. every 2 hours......

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Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.
Does anybody really pee every two hours?? hehe:chuckle

I would, given the opportunity.

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Hey! I work in a LTC facility and we have people who are q 2hr. I on average I usually have about 20 residents under my care each shift. Now keep in mind that I love my residents like they were my own family and give them the kindness and respect that they have all deserved. But when they need to go, weither its q 2hr or just after each meal i try my best to make sure they go. But when I have 2 residents with alziehmers who need to reassured every 10 minutes that everything is fine and they live at such and such facility, and 4 demintia residents whom one of them thinks i have slept with thier husband and i have to calm them down and reassure her that i have not done such a thing on top of all other things i need to do, sometimes q 2hrs dont get done. Its just a fact that will live forever, CNA's are stretched thin.

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Specializes in LTC, assisted living, home-care.

i would love to pee every two hours at work, that would be the best 10 minutes of sitting i would do any given night....lol:lol2:

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Gosh, how are you gonna do that? It's gonna be an "honor" system. If the aides are not honest, they can just check on the sheet it was done whether it was or not. The only thing I know is are linens or clothing being replaced more often or are attends being used for the residents on the program.

I just don't know how you're going to know that it was done unless the CNAs are honest enough to do it and say that it was done, and not lie about it.

True. I see it all the time where I work (I'm a CNA). A CNA will chart that they toileted a resident, when I know for a FACT that she didn't. (For instance, the resident wasn't even THERE all day!) Also, there are some residents that are only on the B&B program for nights. Yet, a CNA will chart for the day shift.

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Specializes in SNF/LTC, ALF, Med surg, from CNA to ADON.

No place can toilet every resident every 2 hours. Who the heck came up with this schedule? I'll bet they figured since you must reposition everybody every 2 hrs you might as well toilet them. It can't be done. toilet at routine times to reduce incontinence, or do a bladder assessment to find when they need to toilet is the only way to accomplish the task. Some folks would rather sleep thru the night, put a brief on them, grease them down with A&D & care plan this. Ever wonder why they fight so much during rounds? Don't nobody wake me up every 2 hours to get me to pee. This means sitting on the toilet 12 times a day. no time for activities, no time for meals, no time for naps. guess there are a lot of tired old folks in this country. and does trying to do the impossible really stop the incontinence? Especially those on diuretics, BPH, CHF, Old bladders?

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Specializes in Gerontology, Med surg, Home Health.

Much of what we still do is based on old systems when nursing homes had mostly people who could care for themselves and probably only had one or two people on a unit who needed to be toileted. It is totally unrealistic to think anyone could toilet 10 patients every two hours. Healthy people do not have to urinate every two hours so why do we drag these poor souls to the bathroom so often? In this new era of patient centered care, we would do better to focus on what makes that particular resident happy. Would they rather spend the day in the toilet with the hope that they will have dry pants or would they rather be able to either sleep through the night or maybe stay in an activity all afternoon?

The same thing goes for bathing. "Honey I'm an old lady and I don't get all that dirty so why do you make me bathe two times a day?" A patient said that to me once and I have to agree with her. For years these people bathed once or twice a week, but now that we have them, they are made to bathe twice a day...it's not right. I'm not saying we should let them all go around stinkin' up the place and if they are incontinent then they should be cleaned, but for the most part, people should be allowed to live the way they want without us imposing our rules on them. (sorry I digressed from the topic at hand)

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