Bedpan dilemma

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I had situation today very upsetting to me and can use some advice. I am an RN in a rehab center was caring for elderly lady s/p fx ankle with surgical repair. She was experiencing major constipation issues. Gave her mom in am no relief then toward end of my shift gave dulce lax supp at approx 2:45 she was calling down hall for bed pan no CNAs around so I went in placed her on pan went back 10 min later she said needed more time so I gave her call bell went in hall spoke to CNA in hall told patient on bedpan he said okay. Then I went to dining area getting ready to leave unit to give report to oncoming shift told second CNA I had put pt on pan and she requested more time and she had her call light CNA said yeah that lady takes along time on pan and said okay. I went gave report to oncoming nurse told her had given supp put her on pan and she was still on and to check with CNAs if had results cause if none would need enema. Approx 2 hours later I receive call at home guest was still on bed pan and had red marks on her bottom. I said to nurse I told 2 CNAs both CNAs denied me telling them and nurse vaguely recalled our conversation. I feel scapegoated they obviously forgot to check and don't want to get in trouble but I feel awful for guest and feel I will take blame cause I placed her on pan. I am a wreck over this any advice.

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Specializes in Short Term/Skilled.

I can only tell you what I do as a CNA. I never leave my shift with a patient on a toilet or on a bed pan, unless they are completely alert and oriented. I would have had her get off of the pan and told her we would try again in a bit so her bottom doesn't get raw. You did report it though, so I doubt anything will come of it, especially since she should have been checked on well before two hours had passed, regardless.

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I am not sure why a resident would be on a bedpan with one fx ankle, would the BSC be a better option for this patient? It is very difficult when one is constipated to attempt a bed pan. Which has not a lot to do with your question, just a thought going forward.

If you delegated to a specific CNA that they were to check on the resident in q15 minutes and report to the oncoming nurse whether the resident had results per the suppository, then it is on the CNA who you delegated to. If you made just a general statement about the resident needing to get off the bedpan, then that is a completely different story, and no one really "heard" you or listened. And that is an issue.

Who was the CNA assigned to the resident? Was that person not around to delegate to specifically? Because you are ultimately responsible to those who you delegate to who are unlicensed, I would have not given report until I was sure that the resident was off the pan. And I try and get the resident to hold the suppository for as long as feasible, for best results. If there were no results, I would take the resident off of the pan, and be sure that they check on said patient in a half hour or so.

Unfortunetely, (and I am shocked that they called you at HOME to tell you this, as I am not sure what you were to do from home), you can only state that at 1500 hours you checked on said resident, who declined to have bedpan removed, as they were actively attempting a BM, therefore, you delegated to CNA Xyz to check on Resident q15 minutes. You then advised oncoming RN of same, and that should the resident not have results, per bowel protocol, patient would need an emema.

And this opens a line of questioning regarding bowel protocols, if residents should be put on a BSC, and a proactive approach to preventing constipation to begin with--ie: bowel meds that can help with this before it becomes an issue. As well as the delegation process of "proving" that you delegate--usually by documentation...

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Specializes in Acute Care, Rehab, Palliative.

You really need to get patients in that situation up on a BSC. I wouldn't have left without making sure she was off.

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Specializes in L and D.

Please tell me you charted all of this. I do not think you were in the wrong at all, but if you didnt chart, it didnt happen.

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Specializes in L and D.

And for the record, i would've left. When you report on a patient, you report repsonsibility, but i sure as heck wouldnt have left without putting in my notes that patient was on a bedpan, needed more time and "enter all names" recieved report on patient's status.

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Specializes in Oncology; medical specialty website.

Having had ankle surgery more times than I care to admit, I was always allowed to use BSC. Was the pt. confused/not alert? Why didn't she call for assist instead of staying on the pan for 2h? When you report off, you are handing over responsibility for your patient's issues to the next shift.

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I don't think the receptacle the patient was on to have said BM is part of the issue. Its laziness on the part of the CNA. Also too, it never ceases to amaze me that the patients have their call bell and will use it to ask you to adjust the covers a half an inch but you reinforce to them to call for help and they don't use it and sit on a bed pan for hours and then complain about it.

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Specializes in LTC Rehab Med/Surg.

I have to agree with the other posters.

Too often I've had my replacement, not remember their promise to handle what I report on.

I usually ask myself "What if they don't" when deciding what I can safely leave for the next shift to do.

I probably wouldn't have left the patient on the bedpan.

The OP probably won't do it again either.

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Specializes in Post Anesthesia.

"Wouldn't have left"? When I'm done with my 12hrs-it's someone else that is in charge of the patients. The fact that the nurse that followed you and the CNA did not pay attention in report dosen't make you negligent or responsible for thier care. I don't work in Rehab/ECF, but I've always believed I can only be responsible for the care I give. I cannot force the other shift to give good care, or to care al all. I don't know what your hand off documentation includes, but a lesson learned- make sure you get a grunt and head nod when passing on something that needs followed up on in a timely fasion. I would ask your director why your are getting a phone call at home when another nurse was responsible for the patient. I would certainly tell her you clearly informed Nurse BobbieSue and CNA BillyJo that the patient was on a bedpan and needed checked on soon (having been checked on once and requested more time). If they chose not to listen to report, you have no way of making them. As for a BSC- It may be an OK idea, but the little lady developed breakdown on a bedpan before someone checked on here. I can just see them finding her on the floor with an overturned BSC and a concussion and/or a broken arm to go with her ankle.

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Specializes in Acute Care, Rehab, Palliative.

I wouldn't have left anyone on the bedpan for more than 30 minutes. if they have n't gone my then I would try again later. Leaving them on too long leaves a red mark and that can lead to skin break down. If you are trying to get someone's bowels to move the BSC is the best.

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Specializes in Short Term/Skilled.

I wouldn't leave someone on a bedpan or on a toilet during change of shift who wasn't alert and oriented, no. I would encourage them to finish up and try again later in the situation the OP described. If they were ready to get up I would do it before I left or I would have whoever was taking my place relieve me and take over the patient care, but unless I see the CNA actively assisting the patient I'm not leaving until I know my pt is being taken care of. Shift change is crazy, things get forgotten and I cant trust a patient who isn't A&O to ring when they're done.

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