Being woken up every 2 hours to change

[Peppermint1288]

Imagine your relative were in a care home, how would you feel about them being woken up every 2 hours during the night to have incontinence pads changed? It's what the management requested.
It's what happened at a home I recently resigned from. Indeed it's not nice to be left soiled, but it's disturbing their sleep by being woken up every couple of hours to be changed. What would you do?

That’s ridiculous - you don’t do that to a baby! As long as they’re sound asleep there is no need to change during what’s a usual sleep window - say 11pm-7am, I doubt much skin breakage can occur in that time

Well actually you would wake a baby to change for poo, not pee though.

It seems a bit strange to routinely change every 2 hours as surely there isn't poo that often? I'd expect poo to be changed as soon as it's noticed but pee can be left:

Every two hours? When you say soiled do you mean a bowel movement or do you mean a pee?

If bowels then maybe some tests because that isn't good.if pee then I'd question the quality of the pads and whether they were the right product. (Absorbent enough etc)

I'd also be asking them about the amount of fluids taken and whether they have considered reducing that in the evenings.

Ultimately they have to make changes because the long term damage caused by not being allowed to sleep for more than two hours at a time is unacceptable. There's a reason sleep deprivation is a torture method!

Do they change the pads every two hours during the day too?

This smacks of poor care imo. On the surface folks might say eh? But surely NOT changing the pads would be the poor care, but failing to appropriately manage personal care needs is a failure on the part of the home.

YABU. Moisture and pressure damaged is literally life wrecking. Also care homes and hospitals are under the constant threat of litigation from relatives. I can see the logic here.

There could be medical reasons why this needs to be done like ulcers? Care homes usually have the mim staff overnight can’t see them making extra work themselves without a medical need.

YABU. If they're soiling themselves then it needs to be changed immediately - otherwise they can get infections and sores and it'll be horrific. You should change your baby every time they poo - even if they're asleep. The problem is that they're having a bowel movement every two hours, not that they're getting cleaned every time.

YABU they could be at high risk of pressure sores like op has said. Hence 2 hourly turns(position change)

Meant like PP has said

Is this for everyone or just those with skin integrity issues? How big is the care home and how many staff were on at night to facilitate this? Is it at least 4/5 changes a night?

Frail and elderly with sores have 2 hourly turns

i used to work in care home, and there were several ladies who had to be checked during the night, as three of them had bowel issues, and had to have pads changed regularly. There was a bell system to ring in their rooms, but they never used it mostly, as they thought it was making a fuss, or they got cut very short with all the messy business, So we were told to keep checking on them regularly.

The other ladies who were just slightly incontinent, had a pad at bedtime, and slept though, and were not disturbed.

If they need pads changed 2 hourly they need a new continence assessment. Pads that are just wet shouldn't need changing more than once through the night in my experience as night carer

@shouldistop I read it too quick and interpreted it as the home wanting them to change the residents even if they haven’t soiled themselves. A quick check should confirm whether they have or not. If they are asking to fully change when there is no soiling that is def overkill. Like you wouldn’t change a baby every 2 hours overnight if there is no poo. Perhaps the residents in question are soiling a lot?

Frail and elderly at rish for pressure sores are repositioned and pads checked (only changed if wet or dirty) every three hours where I work. you can't wait for them to have a pressure sore it's prevention thats the key

That's awful and nowhere else have I heard of this or seen it.
Using proper underwear,a kylie,disposable bed pads is sufficient to allow a decent undisturbed nights sleep.
Every two hours is absurd and abusive.

I wouldn’t like that if it were my relative. Never done care work but I’m an OT in a rehab unit so often see the care logs when doing assessments. The patients usually just press the buzzer if they want the commode or the loo. They’re only taken out regularly if the team have decided there is a specific reason, it’s certainly not standard.

Every 2 hours is slightly excessive if it is a full change regardless of if someone needs it.

When I was fully clinical I may check VERY incontinent and VERY hydrated patients every 2 hours, and even then it was just check! Wake up enough to consent, gently unwrap to check, rewrap and tuck in if not needed.

The standard for the average pt is 4 hours, regardless of setting.

2 hourly changes of pads and position is perfectly routine in a hospital setting for those likely to get pressure damage so I’d be pretty impressed if a care home was doing it effectively for similar patients ( frail , incontinent and incapable of moving themselves effectively) .

There are obviously many who can't use a buzzer to call for help, whether it be physical or mental capacity reasons. Those who can't move themselves, need a positional change 2 hourly and pad checked. Skin integrity can be compromised very quickly and is difficult to reverse in frail people. Allowing skin integrity to be compromised, through lack of care, is a failure to fulfill duty of care. Nurses would be in breach of their Code, if damage due to omission of care could be proven.