Bowel Protocol

[Kimmyjc]

Do any of you have a standing bowel protocol (on admission with narcotics or with initiation of narcotics and certain other medications)? If so, I'd sure be interested to hear what it is. Thanks

[CapeCodMermaid, RN]

two points--

1.In Massachusetts it is outside the scope of nursing practice to "disimpact" a resident. We don't do it...end of story. If we give a suppository, we sometimes "digitally stimulate" the bowels...all semantics

3-11-MOM if no BM in 3 days ---if that doesn't work, 11-7 gives a suppository. If still no BM 7-3 gives the fleets.

2. We have a saying in our center taught to us by a pain specialist who is a nurse practitioner. "The hand that writes the order for the narcotic pain reliever had better be the hand that also writes for Senokot daily or it will be that hand hold the end of the Fleets!"

[CoffeeRTC, BSN, RN]

Ater 3 days and no bm days give MOM, If not effective by the 9 pm med pass they get a dulcolox sup. If not effective fleets in the am. Then call doc if not effective. Dar gon it you better have a bm by the forth day!!

Of course once we need to do this, we are looking at preventing constipation from occurring. We normlly start with colace bid or senna bid.

[dian57]

On admission, we SUGGEST to the doc our normal bowel protocol:

2 days no BM--warm prune juice

3 days no BM--30 ml MOM

no BM in the following 16 hours--Fleet enema

If we use MOM twice in a month, we suggest the doc order a standing Senokot or Colace.

One doc orders look like this: Percocet one with Colace 100 mg q4h PO prn--pain 5-10.

For standing narcotic orders the protocol suggested by our pharmacy consultant is:

Senokot-S 2 tabs at hs

-if not BM in 24h--up dose to BID

-if no BM in 2 days--Dulcolax 10-15mg at HS, then increase to BID

-if no BM on day 3, add Dulcolax suppository

I review the MARs at the end of each month and see if too many prn bowel meds are being used. Then I ask the docs to adjust the standing softeners or laxative orders.

Hope this helps.

[not now, RN]

Our bowel protocol is suggested when a resident is admited into the facility. More often than not the MD has no problem with it. There are maybe three residents that I can think of who don't have any orders but prune juice works fine for them. If a resident doesn't have orders and prune juice no longer helps we'll initiate and fax the MD for an ok. They usually are fine with it.

We have a BM book where CNA's chart and it's ususally the first thing an oncomming nurse checks after the narc count. Each shift has to sign the BM book and if the resident needs MOM, Dulcolax or an enema you sign it out in the BM book, the MAR and give it.

[CapeCodMermaid, RN]

I like the idea of having each shift sign the BM book. I have some nurses who never look at it....can you spell impaction?

[panurse101]

in our facility, we have found that using unifiber, works really well. this is day one of our bowel protocol, and like i said usually works. the protocol is started on day 3, unlike most facilities. this is given on the 7-3 shift, with breakfast and lunch, then the 3-11 shift give mom. day 4 the 3-11 shift gives a ducolax supp. then day 5 the 7-3 shift gives a fleets. our cna's make out the lax list when they are doing their books. they look at any resident that has not gone in 2 full days, then puts them on the list. the 11-7 shift, double checks this list, and makes sure all residents have the order for the "bowel protocol per policy", and sends the notes to dietary to make them aware. it works really well. the problems we did have with it, was not the cna's not marking residents down, but with the nurses for not following the protocol. they dont give anything day 3, then day 4 they give a fleets.???

the unifiber is not like the other fiber drinks, that you dont have to drink 8 oz's of fluid with. unifiber can be given in a small amout of food if needed.

good luck tracy

[tlf91]

In our facility we use "Power Pudding". All natural. bran, prunejuice and applesauce mixture. The residents love it and can not get enough. Ask for more. We use it in out protocol and boy is it effective. We give it at night and the next morning "look out". Works like a charm for us.