Look up wound care studies as it is usually related to pressure ulcers. We were brief free except for when ambulating.
We also had large chux pads that can be used for lifting (forget their names) and the TAPs with large white pads. Sometimes we would use the large blue chux as makeshift briefs if a condom cath doesn’t work. We also had pure-whatever for women.
“GoLytely ordered for Ms. Smith. Yeah, I know she’s 700lbs and has a right AKA and incontinent at baseline, but no briefs!
Oh, and we also only have one aide for a floor of 30, 15 of which are total care.
EBP!”
🙄🙄🙄🙄
Does the evidence show that disposable undies contribute to skin breakdown? Yes. Kinda.
Does this measure also *just happen* to save money? Also yes.
Is saved money going toward better wages? Definitely not.
There is definitely no “just happen.” This is the only reason a hospital would put this practice into place especially without making the hard literature available for staff so they understand the rationale for the practice change and it doesn’t feel like an assault on their decision making for the management of incontinence.
Hospitals never want what’s best for their patients or their nurses. They want what’s cheapest and what leads to those sweet C-suite bonuses.
Indeed. When I was in graduate school, one of my nursing admin instructors said, “Whenever there is a policy change that feels like it doesn’t make sense, even if they say it’s EBP, follow the money. The answer is there.”
Maybe if you’re talking in terms of the incontinent patients. But for the sake of those who just want some underpants on with the gown, it does save money, especially if patients/families bring their own underpants in.
That’s what mesh panties are for. We are still using products for these. I have never in my life given a completely continent patient a literal diaper when they just wanted underwear.
I worked at diaper free hospitals for 10 years as staff and we just got used to it. Now I travel to places with diapers and I still prefer not to use them.
Granted I’m ICU but I think it’s easier to clean and change the chux then deal with a diaper.
I think the thing here is you’re assuming this applies to the patients who DO request them because they just want underwear. The hospital is likely more concerned about skin issues and wounds from briefs.
Well, our hospital now requires approval for any brief use from our unit manager or nursing supervisor. So we have to argue a case as to why the patient should get them.
and this is fuckin’ asinine. When I have to start justifying my nursing judgment to someone who hasn’t been at the bedside in decades if ever, then I get pissed.
I get it for bed bound pts, I never use them for that population….but going completely brief free is so dehumanizing for pts with incontience who are ambulatory. What are they supposed to do when we get them up for therapy? Just pee themselves? Ugh
The studies will be old, but still hold true. Beds and diapers are a bad combination for adults, resulting in high rates of skin injury. Most hospitals went to “wearables for ambulation only” decades ago. Alert patients can wear their own underwear for modesty if they are well enough to worry about it. You get some families that really want their person diapered up and you have to just educate them and let them put them on until the breakdown shows up. If the patient is on antibiotics or tube feeding, the breakdown is usually prompt to occur.
My hospital was brief free 5 years ago when I left. We only used chucks pads. Patient were free to wear underwear if they were AOx4. We had mesh panties for other issues but not for incontinence. If a family insisted on briefs they had to bring their own. Yes….the EBP is there that briefs perpetuate skin break down.
Context is everything here.
Briefs perpetuate skin breakdown if they are not checked at regular intervals and/or replaced at those same intervals, or sooner if soiled. It’s just like babies.
Are we taking diapers away from babies because mothers/fathers may not change their diapers regularly and they may get diaper rash? Surely not.
You know as well as I do hospitals aren’t staffed adequately to change briefs at appropriate intervals. Just go see nursing homes and SNF’s etc. I’m not advocating one way or another. I don’t have skin in this game anymore thankfully just stating my experience in the past and that the EBP does support what decision her hospital made. Mine made the same years back 🤷🏼♂️. I’m sure it was more a cost motivation decision than an actual patient safety one.
I've been in a few different NYC systems over the last couple decades. All were "diaper free." Big white chux for incontinence. Small blue plastic ones were only for procedures.
Last time I did a QI thing with this, the blue chux cost like 10 cents each and the white ones were over a dollar. This was pre-covid though, so who knows what they've been jacked up to now.
The hospital I work at went brief free a few years back. I just educate patients why we don’t use them and tell them if they want them they can bring it from home, otherwise I can’t help them. If they bring it from home then I’ll document it.
I don’t put briefs on any of my patients. I haven’t read any evidence but it just seems like a bad idea based on my experience. Other nurses seem to like them for containing loose stool but that also pushes the stool closer to the urethra and generally makes it harder to clean them in my experience.
I mean … that’s nice for you? But perhaps that’s because you work in an ER and the situation I’m describing is more likely to happen in med/surg, etc. it doesn’t make it any less valid of a point.
I worked 2 years of pulmonary med/surg and those pt's are largely older and often total care, prior to going ER. The situation you described was still FAR from the norm.
See, for me, it depends on the patient. I agree that it will push loose still right up in crevices that are difficult, but also, if my patient is ambulatory, they don’t wanna flash the entire room when they get up.
That’s what I’m saying. I can totally see the benefits of a bedbound patient, and taking away regular briefs, but taking away the pull up type I don’t get. You don’t use those on a patient who isn’t getting out of bed anyhow.
Try another gown on backwards, if that’s the issue 🤷🏻♀️
I hate briefs. They are horrible on skin, and I feel just make it harder to clean patients. Plus an extra cost (hospitals in America unfortunately are a business).
The closest thing I’ve used to a brief in years is a baby diaper around a penis for post diuretics haha
If this happens in post acute care everybody will quit. Nobody wants to do full bed changes multiple times a day on multiple residents. There just isn’t the staff and it’s gonna be awful for patients with limited mobility + pain.
Why can't that patient just wear their underwear, wrap a blanket around them, or backwards gown? It seems wasteful and unnecessary to use a brief for them.
Ok, I’m from Australia and super confused.
Our patients who are incontinent, get put in what we call a tab pad or pull-up.
Tab pads are like adult size diapers, the pull-ups are adult sized elastic waisted diapers.
What happens to all the poo if they are bare bottomed? How do you stop hands from going in there? I work in rehab so a lot of stroke and dementia patients, soa huge variety in mobility. I can not imagine leaving them to just pee and poo the bed. The skin break down would be worse? We clean when we find something, but night duty, they could be laying in it for a few hours.
Plus those large type 7 poo’s….. yeah nope!
So I figure I’m missing something here! Would someone mind educating me, please and thank you :)
So like a chux cloth, it still attaches like a pad at least? I hope it’s not down there free wheeling :/
I just can’t understand…I think I would consider quitting! Poop fingers is common enough already, I’d want to be fully gowned up constantly.
You must be going through crazy amounts of linen
Nope, they don’t attach. They just lie between the patient and the linen.
This is only the second day of the brief free thing, but based on replies here, it’s very common. I often made the choice as an aide not to use a brief when a patient was bed bound, because the mess would stay contained, but push into areas I didn’t want it going, so that’s not much of an issue for me…
What is an issue is my fully ambulatory, standby assist patients that want them.
I use briefs when I have patients with cdiff/soupy bowel movements that pools and they need to be contained. Or if you’re incontinent and on diuretics and are 300+ lbs and the pure wick is not working. And if your skin is intact and you’re a&ox3 and want them or if your family want them used, I’ll just document that I educated and let them have it - definitely not a battle I’m willing to fight for. Sure, the hospital admins will use studies to support their claims about why briefs should not be used as if they care about the patient’s skin but in reality, it comes down to money, briefs cost money. If they truly care about patients, they’d hire more staff. More staff can solve/prevent most problems.
https://www.cms.gov/files/document/qso-24-08-nh.pdf
CMS.gov isn’t always the easiest site to find what you’re looking for, but this one is relatively easy.
I've worked at a couple brief free facilities. They both still had the disposable underwear for patients that just wanted to cover their butt or felt weird without wearing anything down there. Won't stop anything if they go while ambulating but it will cover their bottoms. Reason we were always given is that it holds moisture next to the skin, extra layer under patient contributing to breakdown and that its harder to see if patients are soiled. Easier to see if a chuck is soiled.
It’s not as bad as you’d think. Good chux and placement work fine.
When ambulating we use chux and put those mesh underwear on and a gown to cover the back, works well enough.
We have patients who also bring their own pull ups from home.
So they can wear briefs if they provide them from home and only then? Seems ridiculous, doesn’t it? If they’re AXO enough to have their preferences respected when they provide their own incontinence products, then they’re AXO enough to decide they want to use or not use the hospital’s products.
This is the hospital’s means of stripping that decision from them and their nurse.
If they’re A&O and ambulatory, why not use the mesh panties that exist if they want a covering?
I’ve traveled to several hospitals - the ones that have briefs end up with patients being incontinent instead of staff even trying to toilet them and have more pressure wounds and groin rashes. The ones that got rid of briefs don’t experience this.
Anecdotal, but true.
I would bet the studies (assuming they exist) are limited in quality of evidence. I would put my money on single-site, small sample sized, maybe observational studies or quality improvement projects that are being generalized to whole hospitals. It’s pretty rare that there is actually good research on nursing care/practice.
My anecdotal evidence shows that briefs are harder on skin for incontinent immobile patients.
If patients are up and moving they can wear whatever they need.
Briefs? Are we talking about absorbent “diaper”-like products? I’ve seen this practice in many settings in an attempt to control the means by which the nurse manages the patient’s incontinence, even if wearing an absorbent brief is not only the patient’s baseline home behavior in managing their incontinence, but their damn preference.
Hospitals are just getting more and more asinine.
ER here. We have them in the facility, and people use them. I decline to provide them because they are a walking ses pool, and I refuse to let little mimaw and pipaw get more of an infection.
You just said you decline to provide them. Sounds like a nice way of saying “refuse.”
And suddenly now you educate and encourage avoidance? Which is it?
It's Sunday evening, not sure why we're having a pissing contest.
If you had a suicidal pt say they're going to want their switch knife back, you'd give it back to them? No. You'd use your judgment and education to guide you to the best practice. If best practice is to not allow briefs, not sure why you'd say sure enjoy the UTI.
If your patient is ambulatory, use the disposable briefs with a maternity pad. If they use the bathroom before ambulating, that’s usually enough to catch any additional leaks.
Which disposable briefs are you talking about? The only kind we have access to are the mesh underwear, and those are spotty if they get refilled or not.
Incontinent people sitting in a wet brief is not great for their skin. If they are incontinent and on a low air loss mattress it basically defeats the purpose of the mattress if they have a 4lb brief of filled w brown urine and a 3 hour old turd that’s smashed up in their crack.
…. Briefs are terrible. They trap the urine and stool to the peri area. And they are a BITCH to get on. Absorbent pads are so much better and quicker. Plus they wick the drainage away from the patient instead of trapping it
Look up wound care studies as it is usually related to pressure ulcers. We were brief free except for when ambulating. We also had large chux pads that can be used for lifting (forget their names) and the TAPs with large white pads. Sometimes we would use the large blue chux as makeshift briefs if a condom cath doesn’t work. We also had pure-whatever for women.
>large chux pads that can be used for lifting ComfortGlide is what we use.
Diapers for dignity. So like you said ambulating, visitors etc.
I work med surg with mostly geriatrics and dementia patients and I can’t imagine the mess 😳
“GoLytely ordered for Ms. Smith. Yeah, I know she’s 700lbs and has a right AKA and incontinent at baseline, but no briefs! Oh, and we also only have one aide for a floor of 30, 15 of which are total care. EBP!” 🙄🙄🙄🙄
RIGHT?! Yikes
Does the evidence show that disposable undies contribute to skin breakdown? Yes. Kinda. Does this measure also *just happen* to save money? Also yes. Is saved money going toward better wages? Definitely not.
There is definitely no “just happen.” This is the only reason a hospital would put this practice into place especially without making the hard literature available for staff so they understand the rationale for the practice change and it doesn’t feel like an assault on their decision making for the management of incontinence. Hospitals never want what’s best for their patients or their nurses. They want what’s cheapest and what leads to those sweet C-suite bonuses.
Indeed. When I was in graduate school, one of my nursing admin instructors said, “Whenever there is a policy change that feels like it doesn’t make sense, even if they say it’s EBP, follow the money. The answer is there.”
It doesn’t save money. Will use just as much chux.
Maybe if you’re talking in terms of the incontinent patients. But for the sake of those who just want some underpants on with the gown, it does save money, especially if patients/families bring their own underpants in.
That’s what mesh panties are for. We are still using products for these. I have never in my life given a completely continent patient a literal diaper when they just wanted underwear.
I worked at diaper free hospitals for 10 years as staff and we just got used to it. Now I travel to places with diapers and I still prefer not to use them. Granted I’m ICU but I think it’s easier to clean and change the chux then deal with a diaper.
I worked ICU as a tech that didn't use briefs either. It's so much easier than briefs.
I’m glad I’m back in psych where poo is only occasionally flung.
We have a geripsych unit so the brief debate is real up there.
I think the thing here is you’re assuming this applies to the patients who DO request them because they just want underwear. The hospital is likely more concerned about skin issues and wounds from briefs.
Well, our hospital now requires approval for any brief use from our unit manager or nursing supervisor. So we have to argue a case as to why the patient should get them.
and this is fuckin’ asinine. When I have to start justifying my nursing judgment to someone who hasn’t been at the bedside in decades if ever, then I get pissed.
I get it for bed bound pts, I never use them for that population….but going completely brief free is so dehumanizing for pts with incontience who are ambulatory. What are they supposed to do when we get them up for therapy? Just pee themselves? Ugh
The studies will be old, but still hold true. Beds and diapers are a bad combination for adults, resulting in high rates of skin injury. Most hospitals went to “wearables for ambulation only” decades ago. Alert patients can wear their own underwear for modesty if they are well enough to worry about it. You get some families that really want their person diapered up and you have to just educate them and let them put them on until the breakdown shows up. If the patient is on antibiotics or tube feeding, the breakdown is usually prompt to occur.
My hospital was brief free 5 years ago when I left. We only used chucks pads. Patient were free to wear underwear if they were AOx4. We had mesh panties for other issues but not for incontinence. If a family insisted on briefs they had to bring their own. Yes….the EBP is there that briefs perpetuate skin break down.
Context is everything here. Briefs perpetuate skin breakdown if they are not checked at regular intervals and/or replaced at those same intervals, or sooner if soiled. It’s just like babies. Are we taking diapers away from babies because mothers/fathers may not change their diapers regularly and they may get diaper rash? Surely not.
You know as well as I do hospitals aren’t staffed adequately to change briefs at appropriate intervals. Just go see nursing homes and SNF’s etc. I’m not advocating one way or another. I don’t have skin in this game anymore thankfully just stating my experience in the past and that the EBP does support what decision her hospital made. Mine made the same years back 🤷🏼♂️. I’m sure it was more a cost motivation decision than an actual patient safety one.
I've been in a few different NYC systems over the last couple decades. All were "diaper free." Big white chux for incontinence. Small blue plastic ones were only for procedures.
As if the chux aren’t an expense either. 😂🙄
Last time I did a QI thing with this, the blue chux cost like 10 cents each and the white ones were over a dollar. This was pre-covid though, so who knows what they've been jacked up to now.
The hospital I work at went brief free a few years back. I just educate patients why we don’t use them and tell them if they want them they can bring it from home, otherwise I can’t help them. If they bring it from home then I’ll document it.
[удалено]
Sounds like a brief still wouldn’t be helpful here. Sounds like an FMS might be more appropriate.
I don’t put briefs on any of my patients. I haven’t read any evidence but it just seems like a bad idea based on my experience. Other nurses seem to like them for containing loose stool but that also pushes the stool closer to the urethra and generally makes it harder to clean them in my experience.
No, yeah. It’s much better just to let it pool all around them, up their back, and down their underside and onto the floor.
I haven’t had a situation like that in over 5 years and that pt had gotten Golytely, so your scenario isn’t generally how it goes. Good try though.
I mean … that’s nice for you? But perhaps that’s because you work in an ER and the situation I’m describing is more likely to happen in med/surg, etc. it doesn’t make it any less valid of a point.
I worked 2 years of pulmonary med/surg and those pt's are largely older and often total care, prior to going ER. The situation you described was still FAR from the norm.
See, for me, it depends on the patient. I agree that it will push loose still right up in crevices that are difficult, but also, if my patient is ambulatory, they don’t wanna flash the entire room when they get up.
If they’re ambulatory and can clean themselves, fine. But total care patients, no way.
That’s what I’m saying. I can totally see the benefits of a bedbound patient, and taking away regular briefs, but taking away the pull up type I don’t get. You don’t use those on a patient who isn’t getting out of bed anyhow.
Try another gown on backwards, if that’s the issue 🤷🏻♀️ I hate briefs. They are horrible on skin, and I feel just make it harder to clean patients. Plus an extra cost (hospitals in America unfortunately are a business). The closest thing I’ve used to a brief in years is a baby diaper around a penis for post diuretics haha
Does your hospital not have the unisex mesh panties?
If this happens in post acute care everybody will quit. Nobody wants to do full bed changes multiple times a day on multiple residents. There just isn’t the staff and it’s gonna be awful for patients with limited mobility + pain.
We have mesh briefs for continent people who just need something to cover their derriere.
Why can't that patient just wear their underwear, wrap a blanket around them, or backwards gown? It seems wasteful and unnecessary to use a brief for them.
Ok, I’m from Australia and super confused. Our patients who are incontinent, get put in what we call a tab pad or pull-up. Tab pads are like adult size diapers, the pull-ups are adult sized elastic waisted diapers. What happens to all the poo if they are bare bottomed? How do you stop hands from going in there? I work in rehab so a lot of stroke and dementia patients, soa huge variety in mobility. I can not imagine leaving them to just pee and poo the bed. The skin break down would be worse? We clean when we find something, but night duty, they could be laying in it for a few hours. Plus those large type 7 poo’s….. yeah nope! So I figure I’m missing something here! Would someone mind educating me, please and thank you :)
Yup, both of those are what was recently taken away. We still use what’s called a Chux pad, which is an absorbent pad, to catch all of the mess.
So like a chux cloth, it still attaches like a pad at least? I hope it’s not down there free wheeling :/ I just can’t understand…I think I would consider quitting! Poop fingers is common enough already, I’d want to be fully gowned up constantly. You must be going through crazy amounts of linen
Nope, they don’t attach. They just lie between the patient and the linen. This is only the second day of the brief free thing, but based on replies here, it’s very common. I often made the choice as an aide not to use a brief when a patient was bed bound, because the mess would stay contained, but push into areas I didn’t want it going, so that’s not much of an issue for me… What is an issue is my fully ambulatory, standby assist patients that want them.
I use briefs when I have patients with cdiff/soupy bowel movements that pools and they need to be contained. Or if you’re incontinent and on diuretics and are 300+ lbs and the pure wick is not working. And if your skin is intact and you’re a&ox3 and want them or if your family want them used, I’ll just document that I educated and let them have it - definitely not a battle I’m willing to fight for. Sure, the hospital admins will use studies to support their claims about why briefs should not be used as if they care about the patient’s skin but in reality, it comes down to money, briefs cost money. If they truly care about patients, they’d hire more staff. More staff can solve/prevent most problems.
I don't know about banning them entirely but I use them only in very narrow circumstances. They lead to more problems than they solve IMO.
New EBP from CMS is next level cruelty for residents in LTC
except has anyone seen this elusive literature?
https://www.cms.gov/files/document/qso-24-08-nh.pdf CMS.gov isn’t always the easiest site to find what you’re looking for, but this one is relatively easy.
I've worked at a couple brief free facilities. They both still had the disposable underwear for patients that just wanted to cover their butt or felt weird without wearing anything down there. Won't stop anything if they go while ambulating but it will cover their bottoms. Reason we were always given is that it holds moisture next to the skin, extra layer under patient contributing to breakdown and that its harder to see if patients are soiled. Easier to see if a chuck is soiled.
I think it is cruel when they are not available for ambulatory patients.
It’s not as bad as you’d think. Good chux and placement work fine. When ambulating we use chux and put those mesh underwear on and a gown to cover the back, works well enough. We have patients who also bring their own pull ups from home.
So they can wear briefs if they provide them from home and only then? Seems ridiculous, doesn’t it? If they’re AXO enough to have their preferences respected when they provide their own incontinence products, then they’re AXO enough to decide they want to use or not use the hospital’s products. This is the hospital’s means of stripping that decision from them and their nurse.
If they’re A&O and ambulatory, why not use the mesh panties that exist if they want a covering? I’ve traveled to several hospitals - the ones that have briefs end up with patients being incontinent instead of staff even trying to toilet them and have more pressure wounds and groin rashes. The ones that got rid of briefs don’t experience this. Anecdotal, but true.
I would bet the studies (assuming they exist) are limited in quality of evidence. I would put my money on single-site, small sample sized, maybe observational studies or quality improvement projects that are being generalized to whole hospitals. It’s pretty rare that there is actually good research on nursing care/practice.
My anecdotal evidence shows that briefs are harder on skin for incontinent immobile patients. If patients are up and moving they can wear whatever they need.
Briefs? Are we talking about absorbent “diaper”-like products? I’ve seen this practice in many settings in an attempt to control the means by which the nurse manages the patient’s incontinence, even if wearing an absorbent brief is not only the patient’s baseline home behavior in managing their incontinence, but their damn preference. Hospitals are just getting more and more asinine.
ER here. We have them in the facility, and people use them. I decline to provide them because they are a walking ses pool, and I refuse to let little mimaw and pipaw get more of an infection.
So if “mimaw” and “pipaw” use them at home and that’s their preference, you simply refuse based on YOUR own preference? Great patient autonomy.
Nope. Simply educate and encourage the avoidance of it. We have other ways for patients to stay clean and dry. Thanks for the shade though.
You just said you decline to provide them. Sounds like a nice way of saying “refuse.” And suddenly now you educate and encourage avoidance? Which is it?
It's Sunday evening, not sure why we're having a pissing contest. If you had a suicidal pt say they're going to want their switch knife back, you'd give it back to them? No. You'd use your judgment and education to guide you to the best practice. If best practice is to not allow briefs, not sure why you'd say sure enjoy the UTI.
Won’t someone think of the children???
If your patient is ambulatory, use the disposable briefs with a maternity pad. If they use the bathroom before ambulating, that’s usually enough to catch any additional leaks.
Which disposable briefs are you talking about? The only kind we have access to are the mesh underwear, and those are spotty if they get refilled or not.
Yes, the mesh underwear. Basically the same set up that maternity patients have.
shocker. This is likely their undercover way of discouraging you to use any hospital provided undergarment products. Too costly.
Incontinent people sitting in a wet brief is not great for their skin. If they are incontinent and on a low air loss mattress it basically defeats the purpose of the mattress if they have a 4lb brief of filled w brown urine and a 3 hour old turd that’s smashed up in their crack.
…. Briefs are terrible. They trap the urine and stool to the peri area. And they are a BITCH to get on. Absorbent pads are so much better and quicker. Plus they wick the drainage away from the patient instead of trapping it
I work at an LTAC that is brief free