I know this is not done very often...but does it require an MD's order?

Thanks!

New Grad Lisa

I was thought you must have an MD. order for everything.Maybe check your facilities procedural manual.It might help clarify it.

When you have a patient sitting on the toilet attempting to dig themselves out due to constipation, no you don't get an order. I've only had to do it once, but no I didn't get an order, just documented it very delicately. And of course you gently document as to not make the facility look liable for this. Something like patient was experiencing major abdominal discomfort but with physical assistance abdominal discomfort was relieved upon bowel movement. I was told never to document that the patient had a fecal impaction, because it's grounds for negligence on the facility for not providing enough fiber and fluid or appropriate stool softeners. I'm was probably in the wrong but my patient was fine with no injury and was very happy to be relieved.

Very interesing...thanks for the comment!

I know this is not done very often...but does it require an MD's order?

Thanks!

New Grad Lisa

In a fresh MI, cardiac patients... for me, yes.... 13 plus years in, I won't go to the netherlands without consulting with the MD, there are too many pharmacologic options to NOTstimulate a vagus response. Our facility has no specific policy for or against. I was taught, that anytime you puncture or enter an orafice it requires an order. Now sure we drop a ton of lines and foleys, ng's and what not in an ICU setting with out calling... it comes with knowing our docs and writing a "call" order.

A regular older person without "new" cardiac issues... my peers do it all the time and don't even document it, just ask for stool softens in the am. You'll decide as you go how you practice. Everyone has a different comfort level as long as it doesn't violate policy.

For me, it isn't prudent without one, policys can't cover every instance. Should bradycardia occur, I couldn't say I didn't know better. Again, many, many nurses do without any problems.

You need an order.

Usually there is some sort of standing order.

This is interesting , I was told just last week by another lvn , that lvns are not allowed to digitally disimpact/ That it is outside our scope. Anyone else hear this?

I believe that is strictly an MDs job myself

I believe that is strictly an MDs job myself

Tom - I certainly agree that it SHOULD be, but I've never seen a doctor do it yet! In my 20 years - I've done it maybe twice, and that was at the beginning of my career - it was mostly forbidden at the hospital where I worked.

I've been an RN for over four years and I just did this for the first time a few days ago. I had an order to remove fecal impaction. Patient had no cardiac issues. Was not able to remove the entire thing as the patient just couldn't tolerate it, but did get out a decent amount and passed on to day shift that I was not able to remove the whole thing.

It was a standing order at the nursing home where I worked, though I would avoid doing it at all possible. I have small hands, anyway.

Also, you are never ever ever supposed to chart any form of the word impaction.

Tom - I certainly agree that it SHOULD be, but I've never seen a doctor do it yet! In my 20 years - I've done it maybe twice, and that was at the beginning of my career - it was mostly forbidden at the hospital where I worked.

The ER Im in we passed a hospital policy stating that enemas till clear and disimpactions were not an approved procedure for the ER.

So if the Dr wants it, he does it him or herself

in my nearly 12 yrs of nsg, i've never seen an order to disimpact.

yet it is something i do, at least weekly.

enemas often will not work with the impairments of the pudendal nerve or internal sphincter muscle.

and that is when manual intervention is indicated.

sometimes, i do not have to remove all the stool.

sometimes, the stimulation is enough to get things moving.

but still, it has to be done.

my pts are always lying down (rather than sitting upright), and have never had any vagal incidences.

but i do use judgment, and if someone has a cancer that has infiltrated the colon, i won't mess with that.

that's when i turn to the md, for help.

leslie