Bowel Protocol

wonderingwhy · Oct 25, 2001

Where I work. We have standing orders on admit for all residents. The order is for MOM 30CC PO QD PRN CONSTIPATION. Anything other than that we have to call and get a Physcians order for.

Kimmyjc · Oct 25, 2001

What we're looking for is something like: MOM 30cc po q d prn, if no BM within 2 days give Dulcolax suppository R q 3 d routine, if no BM in 2 days give Fleets, etc... something like that, we have a real problem with prns not being given and we don't want someone to fall between the cracks and have a real problem. We can not have standing orders, however, we can institute a facility policy in which we write the policy and send it to each physician and let them know this is what we will write if needed unless they have an objection (like we have done with our UTI/URI policies and our incontinency protocol). Does anyone have anything like this? Thanks

Sundowner · Oct 25, 2001

In the facility I previously worked for, our standard was to obtain bowel regimen orders upon admission. Whe the Phsician called back to verify orders, we would ask him/her to okay our regimen, which was mom prn for constipation/no bm x3days ducolax x4 fleets x5.

It was then the wing nurses responsibility to check bm records on a daily basis, the bm record was instituted in "report" Daylight shift was to check the board and inform evening shift of who would need what tx, evening shift then would admin the med, nights was responsible for the follow up and would mark the boards accordingly as well as inform daylight of what was effective or not effective. This was quite effective. Nurses at change of shift went over the bm boards together to see who was pooping and who wasnt and the appropriate action was taken and the results were monitored as well.

I hate to see orders for suppositories QOD just for lack of good protocol, Chances are when you call an MD for an order for someone who needs a lax this is what they will give you because they dont want to spill out a Bowel regimen for you. They will give you an order like above, which in many cases isn't needed.

Hope I helped ya!

oh,,, my secret remedy.....I must share this.....I will mix mom with warm OJ,,,,I swear it is like a bomb. Learned this little trick from an old timer...It works wonders.

TracyB,RN, RN · Oct 26, 2001

A little bit of warm prune juice goes a long way, too. Just an ounce or 2 should do the trick

jkw · Nov 4, 2001

In our facility, Our evening med nurse is responsible for checking the bm list. If a resident has not had a bm in the last 3 days, the prn is implemented (mom,ducoolox etc) We also have a fecal impaction prevention program. Fortunately we have a QA nurse that follows up on these residents that trigger fecal impaction risk and monitor hydration status, medication useage & immobility problems. Repeative documentation which proves you have done as much as you possibly can do for the resident to prevent fecal impaction appears to appease the surveyor when they ask "Was this avoidable or unavoidable?" jkw

squaw nurse · Nov 7, 2001

We also had a problem in our facility with constipation/ fecal impactions. Part of the problem was inaccurate documentation by the CNA's and the nurses not taking time to review the daily documentation by the CNA's. To resolve the problem I changed the responsibility of documentation of BM's to the nurses. I just added a line to the MAR for BM's and as the nurse makes her last med pass of the shift, she asks the resident or CNA about BM's, documents this on the MAR and then administers the PRN laxative. Our standing protocal is for MOM & Cascara q3d if no BM, (unless the resident has another ordered routine laxative) and Fleets enema if no result from the laxative within 24 hours.

Deekie · Nov 9, 2001

In our LTC facility we have standing orders from all physicians for bowel regimen. MOM 30 cc PO PRN for constipation and Dulcolax Suppository PR PRN for constipation...this standing order is only good for 72 hours however, and the charge nurses' responsibility is to get a permanent order for any usage over 72 hours. I have found that 30 cc of MOM in 6 oz of warmed prune juice is a miracle for many bowel problems. I usually have to give only one dose ( good old brown cow ). One thing I recommend to my chemo, radiation therapy, and Parkinson's patients' physicians is daily Lactulose of at least 15 cc PO qd as well for maintenance. That particular regimen has done much to assist with bowel maintenance. The chemo and rad tx patients are usually on pretty high dosages of narcotics and ... well the Parkinson's patients just have so little peristalsis, that the lactulose seems to help. I like the idea of the nurses more closely monitoring the BM's though. I know I did as a charge nurse, but I think sometimes that particular task drops to the bottom of the "to do" list when things get hectic ( which is always ). Im thinking that putting it on the 'nursing measures' MARs might just be the answer to remind nursing staff to check more closely.

Thanks for the idea!!!

Deekie

:-)

tinkertoys · Nov 9, 2001

At our Center, we try to have in place for our pts PRN orders for MOM 30cc qd prn, and fleets enemas qd prn. Our 3-11 nurse makes her BM list at start of shift, listing all who have been 2+days without BM. CNT's are aware, and mark off those who go during shift. Then on last med-pass, gives MOM. If no BM next day, MOM is repeated. If still no BM, pt gets fleets enema next day. Most of our pts get colace daily, and many also get sorbitol 2-6 Tbl/day according to BM's. A few have QOD dulcolax orders. When all our nurses follow our protocol, we have pretty good results. There are always a couple of pts with chronic problems who need regular disempactions, but that has decreased with our protocol.

night owl · Nov 25, 2001

I think the BM list should be the responsibility of the nurse. I hope I don't get beat up on this one, but many times I find that the cna's forget to mark the bm sheets therefore causing problems that aren't necessary. Our protocol is no BM in 3 days, MOM. No result? Fleet em!

Which reminds me, anyone familiar with Fleet bank? Ever see their slogan? "Fleet... we make things HAPPEN!" YEAH!

soulwaters · Dec 2, 2001

Anytime a patient recieves a narcotic such as lortab their chance of being at risk for constipation increases greatly. If the Dr. doesn't address this with an increase in their daily medication regimen for constipation you may want to call him and get some new orders.

lovesmarissa · Nov 20, 2005

We use MOM if no BM after 2 days, then a suppository, then an Enema of choice on the 4th day. We have something we call the 11th floor special, named after an oncology floor at the local hospital. It is 500ml warm water, 4 oz glycerin, 4oz baking soda. It's not the easiest thing to give, since someone has to stir the mixture and another to keep the enema tip in place.....it does work on the most stubbon situations though, even when the DRE is negative and there is a concern of constipation.