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Most everyone at Mom's NH uses some sort of incontinence brief. At night or during naps they also lay down a machine washable cotton bed pad to stop leaks from getting onto the bedding, in case the resident leaks through during sleep. For those who get changed on the bed, it also catches accidents or messes that happen during changing. At the Family Council meeting last night we were informed that if a resident uses a brief, they are doing away with these bed pads, as they’re considered “double briefing”, and CNAs have been using them to help position residents in bed...evidently a no no. I am so upset. Bedding is usually only changed once a week, and we all let them know that they better be ready to change bedding almost daily, as we’re not going to accept wet, smelly bedding. If the CNAs are using them improperly, address that, but not this way. I have never heard of this “double briefing” concept applied to a brief plus a bed pad! The Ombudsman was at the meeting but didn’t have much to say about it, and the administration didn’t say much when challenged. My DH told them he wants to see in writing how this decision was made and by whom, and they told him OK. Any advice??

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Update: thanks everyone so much for your comments. DH just got off the phone with the Ombusdman (who was pretty quiet on the subject at the Family Council meeting). She completely agreed with us that it’s poorly thought out, calling a bed pad double briefing is totally BS, and just a cost cutting issue that’s going to backfire. Today she is facilitating the Residents Council meeting and some residents are going to complain. One of these residents ran into the issue yesterday where she had wet through her brief during the night, no bed pad, her bed was wet and she insisted the entire bed be stripped and mattress sprayed. The ombudsman is going to tell the residents and staff that this is exactly what needs to happen each time. Since my DH or I am there every day, she requested that we document for a week the condition of Moms bed (smell or wet), the response we get if it’s an issue, and call her back. And she told him we can complain to the Department of Health if this turns into the fiasco we all foresee.

DH will be there today and he’s on the warpath anyway since I told him she was soaked through to her wheelchair yesterday when I got there. Not really a bedpad issue, but another symptom of a poor toileting process. Grr.
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Toadhall Dec 2018
They should be putting a pad in the wheel chair too to catch the "wet. Oh no! They will call that "chair briefing" and ban that too.
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So what if the staff are using them to help reposition, from personal experience I can tell you that they are really helpful for that! I wonder how long this new policy can last and whose brilliant idea it is - the amount of laundry will simply be switched from bed pads to sheets, and the incidence of pressure sores will increase if staff have more difficulty repositioning and therefor do it less often. Be vigilant and keep detailed records of any negative effects you see.
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I see no reason not to use the pad for positioning the patient. I'm looking at a book titled "Fundamental Nursing Procedures" by Rita Tobler RN, MSN. On page 49 it talks about positioning " when moving a client a nurse can use a draw sheet also called a pull sheet or turning sheet... ". A draw sheet is a regular sheet turned to run across the bed. I'm not a nurse,but I have taken care of people confined to bed. That sheet is very useful. I've used the pad for the same positioning purpose. They don't want to use the pad for financial reasons. Management people are not aware of the actual work being done. The will save laundry with the pad but get alot more laundry and staff time with all the bed changes. So stupid. I know you are upset, but maybe wait to see how this plays out. They may change their minds when the numbers on their spread sheet look worse. You could certainly talk to the omsbudsman privately. They may be quiet at the meeting because they know how this will play out in the end. If the beds are wet, the home is in violation. The policy itself is not a violation. The omsbudsman is picking her battles maybe? This situation is a lot like an airline. If the airline could take out the seats and pack us in standing like on subway at rush hour they would do it. Good luck. Thank you for advocating for your mom and her fellow residents.
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Next time you visit your mother, go in armed with your camera from the moment you enter her room, through checking the condition of her and her bed or chair, and documenting the condition of her clothes, skin, sheets, mattress, wheelchair, etc. Bring a newspaper with you and begin the photos or video showing the newspaper for proof of date of visit.

Moving an old person who cannot assist in repositioning himself or herself without a draw sheet or Chux causes shearing forces on the skin. Examine your mother's skin - bony prominences, buttocks - for pressure ulcers. Learn about pressure ulcers and how they are staged. Check out the National Pressure Ulcer Advisory Panel.
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Toadhall Dec 2018
Great idea with the camera. A cell phone puts a date time and location stamp on photos that cannot be changed. I now realize that I have thousands of photos documenting all sorts of things. When I showed a photo to an administrator, she realized I was documenting. This makes a difference.
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I have never heard of this practice! My husband and mother ALWAYS had a Chux pad undernesth them. With understaffing in facilities, a resident isn’t changed immediately and the pad helps draw wetness away from their skin. Lying in urine or feces causes skin to break down and also causes infections. I was taught it was ok to use an undersheet to help turn my husband.

Wow. I’d be calling administrators of the facility and if you are told the same thing, I’d find your local agency who overseas facilities and give them a call.
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They are discontinuing the use and I am looking into using them. Not only on the bed but the floor around the bed. And we have the big mattress protector in place. Still it is a big pain stripping the bed at four in the morning and doing the laundry as well as washing her or having the bladder go into the empty mode, all over the place. And this is at home no less.
I would want to know just how the NH is going to provide the additional protection to prevent the various diseases and infections this may cause.
The slow response of the hospital to soiled protective underwear was bad enough.
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There is no well-intended policy adjustment that cannot be turned into a complete pig's breakfast when certain types of management get hold of it.

Double briefing bad. Increases length of time between changes = higher risk of skin breakdown. Agreed? Sure! Of course, we're all agreed on that.

Ergo anything that lengthens time between changes is bad. Ummm...

Ergo, anything that *could* be used to enable longer intervals between changes is bad. Even if that's not what you're actually using them for, nor what they are actually designed for. What?! NO!!!

Cotton bed pads aren't great as slide sheets because you get too much friction if there's a shearing risk.

I'm fascinated to hear how much extra time they're scheduling in for all the bedding changes. And extra time for having to move bed occupants while they do that - or are they going to change the bed with the occupant in situ, and have they thought through the additional health and safety factors with that..?

Or, they could threaten any CNA found misusing the pads with keel-hauling. Can't see anything wrong with that option...
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rocketjcat Dec 2018
Definitely the concept of actually using 2 briefs needs to be addressed. I did learn that in some cases that is actually happening in the NH. Better toileting practices need to be looked at for those residents. But saying a bed pad is a brief sounds like administrative b/s. Pigs breakfast indeed.
I feel badly for the CNAs who are already stretched thin...usually 4 for 40 residents on 1st shift. I spoke with one yesterday who was warning me about the upcoming change (as I was changing moms bed) and I told her I hope they were prepared to change bedding much more frequently. She said it will have to be done almost daily! And I swear some of the CNAs have wooden noses. But I sure don’t!
My DH is not letting this go without a methodical rational for the change. He’s an engineer who deals with data, facts, then action, and they couldn’t provide him with any data or facts, just jumped right to action. The ceo is supposed to meet with him next week. I’m going to meet with the head Rn today to see how she envisions implementing this.
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This is insane! I also would love to have a conversation with the person that made this "rule" Actually no conversation just have them work the floor and change a few briefs as well as bedding for a day or two.
I had a fairly large pad for my Husband and I think if I had not had it the sheets would have been changes several times a day. I also used the pad as a "draw sheet" to help position him up or down or side to side in the bed.
Is it possible to change the term of the particular piece of fabric from a bed pad to a draw sheet?
If they still insist on removing and doing away with pads I would...
Make more frequent visits and check the bedding carefully and if it is in the least soiled complain until it is changed.
If this happens more than once file a complaint with the State Health Department.
Post a "review" on Yelp
File a complaint with the BBB
Any other way that you can bring attention to this do it.

It is possible that the short sighted view is doing away with bed pads will cut cost for the laundry. I bet they will find just the opposite will happen.
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Typical administrative decision where the “powers that be” quite literally - don’t have to get their hands dirty.

If in fact, “They” were ever having to do any of the actual work - this moronic policy would have never come to be.

Guaranteed they’ll be plenty of folks - especially the poor souls who have no one from the outside world seeing to their care - stewing in bedding that is repeatedly soiled, left to dry and soiled again.

Its heartbreakingly tragic.

p.s. If your or your husband know and are on friendly terms with any of the other residents - particularly those who are on their own - it would be nice if you could discreetly check on them - and the condition of their bedding. Cause you know that it is the neglected residents who will suffer the most with this further neglect. While it isn’t a pleasant task it would certainly be appreciated by the resident AND it may bolster your position towards reversing this inhuman policy.

p.p.s. - This place is gonna start smelling like a urinal in a freeway rest-stop men’s bathroom.
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Update on my previous comment.
Went into the tv room tonite to check on DW since she was not in the bed.
OMG! found a kitchen chair spotted in large dark brown spots. She was on the love seat wrapped in her huggie. Checked her. Huggie stained as well. Furiously headed to bedroom. Found two over sized things looking like hershey's kisses on the carpet, bed sheet stained also.
Rushed her into bathroom to clean and headoff any infections. She has pressure wounds on her bottom.
Returned to kitchen to clean and disinfect chair. Removed huggie to treat stain. Discovered easy chair with Bed pad had stains on it. Thankfully I keep pads on it.
Chest at foot of the bed has a pad on it, stained also.
Removed stained bed sheet and treated stains. Cleaned carpet with shampoo and vacuumed.
Last but not least, Treated MY SHIRT she was wearing in place of gown for stains.
Sheet, huggie, and shirt to the laundry for wash and dry.(note: it is a king sized bed.
I get to make the bed for the second time this week. Making a king sized bed is no easy task for a 70+ year old, old man ain't easy. It is not consided to be exercise by the FEDs either.
And these resident facilities want to discontinue using pads? It is evident to me they have very little experience cleaning up a person and room for this type of incident. Their plan will cause other patients to go without routine service and care. Not to mention this will lead to our family members exposed to fecal waste and infection.
I agree that this is all just a scheme to increase charges and wonder what may be next on their list.
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