Doctor's order needed to perform digital feces removal?

[BrandonLPN, LPN]

So I was informed recently that a doctor's order is needed to perform manual feces removal. Has anyone ever heard of such a thing? I always assumed this was purely a nursing intervention. I have a few para/quadriplegic residents residents who don't respond to our bowel care protocol (MOM, then suppository, then Fleets) and on the 4th day I automatically remove the stool manually if there haven't been results. Isn't this standard practice across the board?

I was told this is an "acute intervention" and as such needs an order. Policy is policy, of course, but it seems extreme to me. I know there's vaso-vaugal (sp?) risk, and risk for trauma. But all nurses should know how to do this safely.

[amoLucia]

In recent years, most places I've worked no longer do manual disimpactions. Now your -plegia population may be different and it would be appropriate to have it as an order. Maybe it should be included into your protocol - just to be on the safe side (and care-planned also).

I've learned of another rational for avoiding that procedure because of complaints of abuse having been made (assaultive and kinky kinds). I'm not kidding - being honest!

PS - it's VAGAL. Vaso-vagal - you were close!

[Tait, MSN, RN]

Always needed an order for me, but I knew an old school nurse who would do it regardless of orders.

[Jory, MSN, APRN, CNM]

So I was informed recently that a doctor's order is needed to perform manual feces removal. Has anyone ever heard of such a thing? I always assumed this was purely a nursing intervention. I have a few para/quadriplegic residents residents who don't respond to our bowel care protocol (MOM, then suppository, then Fleets) and on the 4th day I automatically remove the stool manually if there haven't been results. Isn't this standard practice across the board?

I was told this is an "acute intervention" and as such needs an order. Policy is policy, of course, but it seems extreme to me. I know there's vaso-vaugal (sp?) risk, and risk for trauma. But all nurses should know how to do this safely.

If they telling you it requires an order, then it does and that is pretty much the end of the story.

No, not all nurses know how to do it safely....that, I can tell you.

[chrisrn24]

I have heard that you need an order as it is invasive.

[Morainey, BSN, RN]

Yikes. The only time I have had a patient who needs disimpacting, the doctor did it. I am eternally grateful. Especially after he came out of the room, took off his yellow gown he stole from an iso cart, and informed me that the patient just about had a baby in toilet.

[OCNRN63, RN]

Wouldn't do it without an order.

[JustBeachyNurse, LPN]

My fundamentals book stated physician order required. This is not a basic nursing skill so I'd say many nurses would have no clue how to safely or correctly perform a manual disimpaction.

[BrandonLPN, LPN]

Huh, ok. Like I said policy is policy, but I was just curious how other facilities handled this. I really assumed this was among the most common of nursing skills, interesting to know it's not so common.

Thanks for the replies.

[november17, ASN, RN]

We require physician orders. Vasovagal is no joke. Best not to do it unless its absolutely necessary.

[SaoirseRN]

Where I work we aren't even allowed to do this anymore. The physicians must do it themselves.