Proper way to give suppositories

[agldragonRN]

hello allnurses!

i need your opinion on something.

i am an lpn in ltc. we have several floors or units in my building. one floor is being renovated so that floor is dispersing its patients to any floor that has available rooms. we received one female patient from that floor a couple of weeks ago and she is alert and oriented x 3 with physical deformities so she is unable to care for herself. she is not ambulatory but she can propel herself with one arm in the wheel chair.

anyway, she gets dulcolax suppository every three days and she likes to get it while she is sitting on the toilet chair. mind you, the toilet is low and she wants me to bend over (i'm 6 feet tall) and insert the ducolax without seeing the rectum. so the first day she was transferred to my floor, i did it her way because that's how she's been getting it from her old floor. it was very difficult for me because i had to feel for her rectum first because i could not see anything even with me bending and my face was so close to her crotch because the toilet is low and no extra room so i did it through her front. i told her afterwards that it was difficult for me and bending that low was not good for my back.

the next time i gave it to her i asked her to stand for me and hold on to the rails and i will insert the dulcolax that way. the c.n.a. was there supporting her back. i inserted it quickly and put her back in the toilet chair. she resisted at first but i've been doing it that way ever since.

i thought everything was fine but today the nurse manager on her old floor came up to my floor and spoke to my nurse manager and said the patient came to her and complained that we changed her routines. my nurse manager said to her that she agreed with me asking the pt to stand up. then the old nurse manager said she will go to the don and report this. my nurse manager said ok report.

so the old nurse manager came back and said to my nurse manager that our don said we have to follow what ever the pt wants. so when i came to work at 3pm, my nurse manager told me what the don said per the other nurse manager.

i told her i totally disagree with that and i am not going to break my back and plus suppository should be given when the pt is in bed. but no the pt wants it when she's on the toilet and exactly at 5pm. my nurse manager said she agrees with me and i should write a memo to the don.

then a couple of hours later i saw the old nurse manager and asked her what the don exactly said. she said if we have a problem go see the administration. so i explained to her i am tall and it was difficult for me to bend and i needed to see the orifice so i can insert the med properly. she said i did not have to look at the orifice and “just insert” it. she also said her staff did not have a problem when this pt was on her floor and why are we having problem following patient's routines.

so my questions to you guys, is it worth fighting this? should i just sacrifice my back to make the pt happy especially the don said we have to follow what the pt wants? is there a better way of giving suppository? i was taught in lpn school that i should be able to see the orifice before inserting suppository and proper body mechanics dictates that suppository should be given when the pt is in bed?

am i wrong?

thanks for your advice and for reading my long post!

angel

[Tait, MSN, RN]

This is a bit of a tough one. I guess I have a few questions. Forgive me, I work acute care so these situations are a bit foreign to me (not the suppository, but the residency).

1. Is it possible to not be assigned to her?

I was going to ask if the patient might compromise on the situation if she understood your plight, but I am assuming from her conversation with the DON she probably isn't.

I really don't know what to tell you.

Tait

[PolandM]

Tell her to take the one hand she uses to propel herself in a wheelchair and to do it herself. I wouldn't risk my health or well-being for anyone. Request another assignment. Is it possible to get the route changed to po?

[Jules A, MSN]

Proper way to give suppositories?

Hmmm unwrap it and hand them a glove? I've been spoiled by psych.

[Tait, MSN, RN]

Proper way to give suppositories?

Hmmm unwrap it and hand them a glove? I've been spoiled by psych.

I smiled :)

[Emergency RN]

i would suggest that your don looks into why a nurse manager is so focused on the care being given by a colleague's unit. there may be more than meets the eye here, and your "case" could just be a symptom of greater political machinations that you haven't been privy to. you've become the bullet in a battle between two factions, so it may be wise to do like one of the other respondents stated, ask for another assignment.

that said, follow your hospital's policy and procedure manual to the letter. if they want to amend it hospital wide, let them do it in writing in the p&pm first. otherwise, stick to the manual. if anyone tells you different, advised them that you're not allowed to violate institutional policy for anyone (special emphasis on the anyone, including dons, rn mgrs, mds, pts, visitors, etc.) as you work for the institution, and ultimately have to answer to them. that is, even the director of nursing, cannot violate institutional policy and procedures. she may endeavor to change it, but she, like all employees, remain bound by it.

good luck.

[agldragonRN]

i cannot switch assignment as i have that wing for the whole month then i switch to the other. other nurses asked her to stand also when i am off because they have the same issues as me.

i heard that the patient old floor catered to anything the pt wants especially the unit manager. the former unit manager would come to my unit a couple of times a week to check on her.

thanks for the idea about changing the route. i will ask my unit manager and md if it is possible to change it to po. i doubt it though because if she wants it per rectum, she wants it per rectum. the other floor spoiled her so now my floor is suffering because my floor is different. we have way more patients than the other floor.

like what i said i work in a nursing home and is it really "whatever the pt wants, we do" rule everywhere? even in the hospital? i'm planning to work in a hospital when i get my rn (soon) and i am afraid it will be the same as long term care?

nobody answered my primary question yet, is it really ok just to insert suppository there without seeing the orifice? shouldn't it be done in bed where you can raise the bed appropriately so the nurse is using proper body mechanics?

thanks for all the replies.

angel

[Emergency RN]

Administration of a suppository requires the identification of the anal opening. This generally mandates one being able to visualize the orifice. Though it may be argued that the anal opening can be identified by palpation, and that the suppository can thus be administered by blind insertion; I suspect that most would view this as being suboptimal practice.

The other obvious question that comes to mind is why is this patient being so anal (no pun intended). There seems to be a tremendous emotional stake over control and it may be worthwhile to have the patient undergo a psychiatric evaluation. The resolve that she steadfastly clings to may be indicative of other as yet unidentified emotional issues about her illness and sense of being.

[montinurse, BSN]

Nursing homes have policy and procedures that have to be followed, just the same as hospitals. I would dig that policy out and stick to it! And the proper way to do it is by visualizing the rectum. There's no way you can be 100% sure of what you're palpating through a gloved finger!

[Tait, MSN, RN]

To be candid and bordering on crude: I need to visualize, because rooting around blindly looking for a person's orifice borders on inappropriate.

That is all I am going to say about that. >.>

As far as the hospital goes, there are many horror stories of customer satisfaction gone awry, but overall my experience is when in acute care there isn't room for much more than protocol and policy.

Tait

[KungFuFtr]

Wow! Talk about micro managing! The old manager shouldn't undermine your manager's authority for something so petty and she should police her own. The reasoning is silly. It's not ergonomically correct nor is it proper biomechanics to perform it her way. It's also pretty nasty to stick your hand past her lady parts and blindly insert the suppository with your face near her crotch.

I was always taught the the PT should be in Sim's position. I would think the toilet method wouldn't be effective because you wouldn't have the wrist leverage to slide the suppository close to the rectal wall; thus you'd insert the suppository into the fecal mass. Not desirable. I'd probably tell the old nurse manager that you won't discuss the pt's care due to Hippa rights. If the old nurse manager wants to break her back; stick her arm halfway in a toilet and place her face close to someone's crotch I'd give her the green light.

[sunnycalifRN]

Wow, this is another example of "the patient is always right" gone wild. You should not have to put yourself at risk of injury to insert a suppository. Maybe you could mention to the patient that the suppository should be inserted prior to sitting on the toilet for optimal effectiveness?

We had a similar situation with a chronic patient who came in to the unit. The patient's wife/caregiver presented nursing and the ICU team with a three page long, typed list of care requirements for her hubby. The list included minute details such as when to turn on the TV, to what channel, how many volume "bars" and also what order to give his oral meds (9 pills on days), 1st ASA, sip of water (no ice!), next lisinopril, etc. The ICU team just typed up the entire list and put it in as a nursing text order (they don't have to do it!!!). We took it to our nurse manager who just laughed and said to do our regular nursing care and let the wife take care of her "list of demands".