Do you need a doctor's order?

[veegeern, BSN, RN]

Do you need a doctor's order to disimpact a patient or to irrigate a foley catheter? These came up this weekend, and everyone had a different answer. (There were orders for both of these.) Is there anywhere I can go to find these answers in writing?

[RGG]

I can only speak from my experience and the standard of practice in the facility where I work. You definitely require a Dr's order to irrigate a foley. Where I work though I do not require an order to disimpact. You would definitely want to look up the patient's medical hx, specifically pertaining to any cardiac hx.

[leslie :-D]

yrs ago, i had a question re: the need for an md order.

there was nothing in our p&p manual.

i wrote to my state nsg assoc and they couldn't help me.

i went to my bon, and even they had me running in circles!

but- when all else fails, go to your bon and try to get an answer.

document who you spoke with, dates/times, etc., should it ever come back and haunt you.

leslie

[TheCommuter, BSN, RN]

I work at a nursing home where I manually disimpact my geriatric patients on a frequent basis without an order. I'd rather finger the poop out of their rectum now than deal with the inconvenience and paperwork of sending them out to the hospital for obstipation or something worse.

[leslie :-D]

I work at a nursing home where I manually disimpact my geriatric patients on a frequent basis without an order. I'd rather finger the poop out of their rectum now than deal with the inconvenience and paperwork of sending them out to the hospital for obstipation or something worse.

i know a nurse who digitally disimpacted a pt and perforated his colon.

she (the nurse) and the snf were the recipients of a major lawsuit.

sh*t happens.

leslie

[TheCommuter, BSN, RN]

i know a nurse who digitally disimpacted a pt and perforated his colon.

she (the nurse) and the snf were the recipients of a major lawsuit.

sh*t happens.

So very true.

[wooh, BSN, RN]

When in doubt, get an order. When in doubt frequently, get a standing order.

[LoriAlabamaRN]

A standing order would be a good idea as a cya policy. At my LTC facility, digital disimpaction does not require a doctor's order, we just do it when it's needed.

[veegeern, BSN, RN]

Thanks to everyone who replied. I see that there is not a universal "yes" or "no" answer, and I really appreciate the info r/t getting an answer for my state/facility.

I asked 2 LPNs this question last night. They both have years of experience in this facility. Both started out stating that an order is needed, but then backed up and qualified it with "it depends on the doctor" and started naming names.

Needless to say, I'll be doing some investigating.

Thanks again!

[RedHeadRN2b]

sh*t happens.

No pun intended...right...?

[ONSnrs]

veegrn,

be careful whether you have a doctor's order or not about disempacting patients that have a low platelet count. Always question a doctor that wants to disempact a pt. w/ a low plt count, the vascularity of the rectum makes it very dangerous.

[P_RN, ADN, RN]

When in doubt-don't. Any invasive procedure needs covering by an order, a standing order (in black and white), or an absolute coverage in a procedure manual recognised by the medical and nursing staff. "We always do it." unfortunately has no legal or ethical standing.