Coworkers Reporting Powerful Bowel Movements

[SilverBells, BSN]

At our facility, we've had a few bowel obstructions.  As such, we've all become hyper aware of bowel movements.  One thing I've noted is that some will chart "Resident had a powerful bowel movement" I'm not sure, but don't recall being taught in nursing school to document a bowel movement as being "powerful."  What are your thoughts on this? Does this make sense or does it make us sound uneducated when we document lime this? 

[CABGpatch_RN, BSN]

I had to delete my original comment.

How can you possibly be, Silverbells a Nurse Manager with or working toward a Master's Degree?  Are you even an RN?  LVN?  

The reason I take issue with your posts is for one reason only.  That is that some people get sent to this site on a Google search on, for example, "powerful bowel movements."  And this is what they land on.  Or your DNR thread or your office space thread, threads ad nauseam.  

And to me it's embarrassing to professional nursing.  I mean  really what is your role?

[SilverBells, BSN]

17 minutes ago, CABGpatch_RN said:

I had to delete my original comment.

How can you possibly be, Silverbells a Nurse Manager with or working toward a Master's Degree?  Are you even an RN?  LVN?  

The reason I take issue with your posts is for one reason only.  That is that some people get sent to this site on a Google search on, for example, "powerful bowel movements."  And this is what they land on.  Or your DNR thread or your office space thread, threads ad nauseam.  

And to me it's embarrassing to professional nursing.  I mean  really what is your role?

I am a nurse manager at a rehab facility.  RN of 6 years. All of the issues I have brought forth are, unfortunately, legitimate.  I do understand your concerns about professionalism but my workplace is not exactly known for that.   As you are probably aware, we are not supposed to use initials or credentials we do not legitimately have per Terms of Service.  I have abided by that and do have a BSN, going to be MAN.  With that said, I am still rather new to the management role as well as in a leadership position, so do need advice here and there.  This thread was designed to discuss the legitimacy of documentation which, as you should know, is important to the nursing profession.   

[NRSKarenRN, BSN, RN]

One of the important aide functions  in SNF/Rehab is recording bowel movements since constipation significant issue in the elderly.

Sounds like an in-service on Bowel documentation needed including use of Bristol Stool chart + language describing stool. include need to notify Charge nurse of ongoing constipation/diarrhea.

 

American Nurse Today Jan. 2015

Refining stool consistency descriptors can help prevent adverse outcomes

Quote

...On our long-term care (LTC) unit, we identified the need for a standardized tool to describe stool consistency and form. We recognized that the older adults we serve have unique needs for accurate stool assessment—namely, avoiding discomfort and adverse events, such as bowel obstruction. When describing stool, our nursing staff met challenges because the only relevant terms in our EHR were "formed,” "soft,” "unformed,” and "multiple diarrhea stools.” Also, based on chart reviews, we found inconsistent documentation of stool characteristics on that unit. This raised the risk of adverse events and patient discomfort, as clinicians were making important care decisions without accurate data. ...

Might be a good project for your final MSN classes. Constipation is a real concern due to side effects of medications, especially narcotic meds post op/l ong term use.

When I worked SNF eons ago,  Many residents responded well to this Constipation recipe --made up by the kitchen, dished out with bedtime med pass -- 1 to 2 tablespoons standard dose, Prevented bowel obstructions.

Quote

Mix together:

1 cup apple sauce

1 cup oat bran or unprocessed wheat bran

¾ cup prune juice

https://www.medicine.umich.edu/sites/default/files/content/downloads/constipation-recipe.pdf

 

[JBMmom, MSN, NP]

It seems to me that maybe one person documented a "powerful bowel movement" for whatever reason they thought it was appropriate and then others thought that was maybe a good description and have copied it. I would not think that is the best descriptor, as others have mentioned the Bristol stool chart can be important and a documentation of the relative amount of stool. Maybe your educators can come up with some standard wording around this issue. 

[amoLucia]

Did anybody just ASK a documenting staff member to DESCRIBE what was meant by 'powerful'??? Never heard a BM described as such.

Most innovative teaching trick I ever saw was that of another SD nurse in NH who hand-made samples of various 'poops' out of play-doh. Then she even painted the samples for her teaching CNA classes. So clever!

Ah! The recipe for 'poop juice' as we called it at a place I worked. Only the 7-3 nurses passed it out at that place. Almost everybody got a dose; never had any constipation problems at that NH. 

[Davey Do]

Oh crap...

[MPKH, BSN, RN]

If you do not understand something your staff has charted, you should speak to whoever charted the unclear statement and ask for a clarification. If you do not deem the charting to be professional, you, as the manager, can implement changes.You, as the manager, can also set guidelines on the unit’s charting.

 

[Davey Do]

This looks like another job for nurse obvious...

[hppygr8ful, ASN, RN, EMT-I]

NRSKarenRN said:

I just love that you used the Bristol Stool scale. It is a powerful teaching tool. In answer to OPs question I don't think "Powerful" is the best descriptor for a bowel movement. The way we used to chart it in the LTC rehab was "Patient had a (small, medium, large), (hard, soft, liquid) bowel movement. In California this is the way the the State inspectors like to see the documentation."

Hppy  

[cardiacfreak, ADN]

I have used "explosive" before.  The patient was having diarrhea and when he went to sit on the BSC it just came out full force, spraying all over the room.  As a hospice nurse we are taught "to paint a picture of decline" explosive was as descriptive as I could be!?

[TriciaJ, RN]

The only time I could describe a BM as "powerful" would be when I worked psych.  We would routinely receive overdose patients from the ED where they had received charcoal and Ipecac.  Projectile vomiting and projectile diarrhea would ensue.  We often found ourselves washing walls.

Of course no one thought to use the word "powerful".  It's not a good descriptor generally and your staff should be discouraged from using it.  We didn't have to describe the stool or emesis; both looked exactly like the liquid charcoal the patient had previously been given.