Case Review: A 60-Bed Ontario LTC Home Rebuilt Its Brief-Change Schedule After a Skin Audit

3 octobre 2026

A 60-bed Ontario long-term care home rebuilt its brief-change schedule after an internal skin audit found that changes were clustering at shift handover. Residents were being checked on time but changed late, and the gap was showing up as redness on the sacral area. The fix was a revised round structure, a clearer product mix by shift, and a check sheet that tied every change to a time.

What did the skin audit reveal?

The audit reviewed a month of change records against the home's own skin assessments. Two patterns stood out: most changes happened in the first hour after handover, and the longest gaps fell in the early evening when staffing thinned out. Higher-absorbency briefs were being used at random rather than by time of day, so some residents sat longer than their product justified while others were changed early. Skin scores tracked the gaps almost exactly.

How was the change schedule rebuilt?

The team mapped each resident's typical voiding pattern and set prompts around it rather than around the shift clock. A 3,000 mL daytime brief became the standard daytime product, with a heavier overnight option reserved for the sleep period. A five-layer 60x90 cm underpad went under residents who were repositioned on a fixed cycle, which cut the number of full bedding changes. Every change was logged with a time and initial.

What results followed?

Within six weeks the spread between the shortest and longest interval had narrowed sharply, and the sacral redness scores improved on the next audit. Staff reported fewer emergency changes because the new rounds matched when residents actually needed attention. The home also ceased mixing absorbency levels, which simplified ordering. The table summarises the before-and-after picture.

Adult incontinence brief shown for day-use absorbency in long-term care

Measure	Before	After
Change timing	Clustered after handover	Spread across the shift
Product mix	Random absorbency	Set by time of day
Skin audit score	Sacral redness noted	Improvement on next round

What did the home change about procurement?

The home moved to two clear daytime and overnight lines instead of a mixed shelf, which made par levels predictable and reduced over-ordering of the wrong product. It kept the underpad and brief lines separate on the storeroom shelf so staff could not substitute one for the other. The documented schedule also became the home's evidence trail for the next provincial review.

What can other homes take from this review?

Three lessons generalise. First, audit the timing of changes and not just the total, because a correct count can hide an uneven distribution across the shift. Second, let the product mix follow the clock, so heavier absorbency is matched to the longest interval rather than to a single house rule. Third, keep the log simple enough that staff complete it during a normal round, since a form that takes several minutes tends to be abandoned by the second week. Homes that copy the revised schedule but skip the timing audit usually see the same clustering return within a quarter.

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