continence management

Our 3-11 nurse always gives suppositories and enemas at the very end of her shift so MY night staff has to deal with the aftermath.

Can be at anytime, if the patient hasn't had a BM in 3 days.

We give them on 3-11 shift, usually after supper time cause that is about the only time we have time to do it. We haven't had any complaints about the timing we give them and i believe they have been doing it this way for YEARS.

Ideally, suppositories should be given about a half-hour after a meal, to make use of the gastrocolic reflex... in the rehab unit I used to work in, they were given at 6 pm. Also, if possible, a bowel program should reflect the routine the patient had at home.

The ideal time to have a Bowel Movement is first thing in the morning. I will explain why- a constipated patient getting an enema or suppository will probably experience pain with the resulting movement. To do so at night will mean that the patient may have trouble sleeping and at best will have nothing to distract her/him. OTOH you give the suppository or enema when you notice that the patient hasn't moved her bowels in 3 days regardless of the time! (I wouldn't want to let a patient suffer)
In our facility we try to give blended prunes, ensure adequate fluids, physical activity (if possible) and if necessary oral anticonstipative syrups or med (or Metamucil if necessary)
We really have kept the number of patients requiring suppositories down for many good reasons- it is time consuming and uncomfortable and demeaning to the patient.
You never want to give the suppository or enema in the bathroom where you can't see where your'e inserting it. ALWAYS in bed, with the patient lying on her/his side, provide privacy and proper lighting, give explanations (even to the dementia patient) and never with a noncompliant (thrashing) patient. to cause a perforated rectum can cost the patient his life and your license!!!
We have our night nurse moniter the BM records and give suppositories or enemas at 6 or 6:30 so that the morning staff can sit the patient on the toilet or shower chair.. an empty bowel will do wonders for their apetite at breakfast and help them start the day comfortably (increasing compliance)
Mornings are when the body releases hormones that will enable the patient to deal with the BM better than evenings when the patient is tired
Hope this helps!