PRN ducolax suppositories, okay to give right before shift change?

Nurses General Nursing

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We got a little sidetracked on another thread about this subject. From my point of view, it's perfectly fine for night shift to give a suppository at 6 AM, even if the next shift deals with the results. I have no problem with that. I think it's best to give a suppository at a good time for the pt. If a nurse at shift change told me that she just gave a suppository to a pt, I never would think that she was trying to pawn her work off on me. If I was working nights, I would not give a suppository until after lab had come and woken up the pt, which would mean that would be at about 6AM.

When I worked LTC, the policy was that the nightshift checked the BM records and gave them at around 6AM or so. That meant that possibly the next shift would be dealing with the results of these oftentimes incontinent pts. I never heard any complaints about that.

Yet someone on another thread thought that it was inconsiderate to the next shift. What do you all think of this burning issue?

Specializes in High Risk In Patient OB/GYN.

Well, in all the LTCs I've worked for, there were a slew of 6am meds to be given anyway, and the PT is awake anyway because the CNAs wake them starting at around 5:30am.

As per policy at every place I've worked at, if no BM by 6am, suppository would be given at that time by night nurse. In fact, days would get md if it wasn't done, because that was one more thing for them to do. (evenings would give the MOM the night before at 5pm I believe--which is, excuse the pun--a crappy time to give it)

From what I've heard from the CNAs, they get the Pt's up so early so that it's not unfair for the day shift, because they'd complain that they did all the work. (Because then an 11-7 CNA would really not have much at all to do otherwise-save for accidents, while a 7-3CNA would have to wake, dress, feed, shower, lotions, etc.

So it's more to even out the work load than anything else/ Also helps the LPN when passing meds. Certainly has NOTHING to do with resident preference or convenience.

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Ideally the resident is supposed to be sleeping at nite - not sitting on the bedpan - but what I've found is that the day girls pay absolutely no attention to the BM lists we give them of people who haven't gone for days - SO - I've started treated them before the end of my nite shift - with the blessing of the ADON.

Someone has to do it, and maybe the day people ARE too busy to pay attention to those things, but like I pointed out to her - if state gets ahold of our BM book - THEY'RE gonna crap!!

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Specializes in Critical Care.

Policy is one thing; I can't speak to that. However, policy issues aside:

Routine bowel habits are not emergencies. IF you get into the habit of giving your laxatives at shift change, it WILL look like you are attempting to dump the 'scut work' onto the next shift.

That being said, I would not automatically think that about a particular situation or event, but if the same nurse routinely 'fixed' these types of problems just in time for my shift to start, I would consider that to be pointedly and purposefully rude. It might be a 24 hr job, but when you start trying to plan the unpleasantries to occur opposite your shift, that is mean spirited, or at least, rude.

Are there nurses that would do that purposely to 'get' the next shift? Yep. In fact, there was a thread here once about a couple of nurses that were found guilty of battery to their patients because they were purposely laxing them up for the next shift.

~faith,

Timothy.

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Reading through this thread is cracking me up actually. Nursing is sometimes an awfully funny business. I mean, such unique dilemmas, don't you think?:clown:

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Specializes in Critical Care.

Took me awhile to find the thread I referenced above:

Nurse pleads guilty for giving laxatives:

https://allnurses.com/forums/f195/nurse-pleads-guilty-giving-laxatives-patients-98407.html

"Authorities say Susan Mejak and another night shift nurse at Willowood Care Center gave extra laxatives to patients in order to make work unpleasant for day shift nurses. The other nurse was sentenced last week to 10 months in prison after pleading guilty to patient abuse charges."

~faith,

Timothy.

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Specializes in ICU, nutrition.

I've always thought it was kind of rude to get in report "I just gave him a Dulcolax supp." I am an ICU nurse (now PRN) and a nutrition support RN (full-time), and I actually write orders for those dreaded bowel management meds. If I get that late order for a supp, I always save it for the night nurse and offer to give it if they want me to. If I write the order, I do it early enough in the day that the day nurse should have plenty of time to give it before shift change.

I realize it's totally different working with 2 pts vs 6-8 vs 40+.

Konni

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Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
So then, it's better for nights to skip the whole thing and let days take care of it?

From my perspective yes. As a day nurse, I don't mind doing the bowel care.

I understand it might be different in LTC. I work med-surg.

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Specializes in Geriatric and now peds!!!!.

At my LTC facility the scheduled bowel meds (MOM/suppositories) are given at 9pm to work overnite. Now as far as the prns, if day shift had given a prn bowel med right before I came on duty ( I work 3-11) I have no problem with that. If a patient has not had a bm in a couple of days, why make them wait and be more uncomfortable?

Wendy

LPN

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Specializes in Neuro ICU, Neuro/Trauma stepdown.

how about when doing chart checks you decide if your pt needs the suppository and give it on your first med pass. then, not only do you know that it was given, but you know if it had effect.

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Specializes in Critical Care.

Granted, I work in critical care so it's a different focus. But this concept held true even when I was working on Med/Surg:

First, laxatives are rarely 'emergencies', and we aren't talking about bowel preps for procedures - they have their own timeframe.

But, If I feel a pt needs a laxative early in my shift, I give it early in my shift.

If I decide late in my shift that a laxative is needed, I normally tell the next shift that I think a laxative is needed, and they are welcome to wait until later in their shift to give it so that it bounces back to me.

If I'm not coming back that next night, and I decide late in the shift a laxative is needed, I defer that assessment to the next shift: I tell them about my assessment and let the next shift decide the best time to give it.

Of course, all bets are off if pt is alert and oriented and requesting a laxative. In that case, they normally dictate the timeframe.

But, these general guidelines have served me well. If I'm giving a laxative late in my shift, in my mind's eye, there has to be a REASON that I can clearly articulate to the next shift why this is NOT me trying to 'burn them'.

~faith,

Timothy.

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Wow...this is such an issue in my ltc. Just about every one of the residents have some form of bowel issues and many are taking meds for them. The big problem we have is nurses checking the records and giving the prns. I can't tell you how many times I've come in to find people haven't gone for 4-5+ days. At this point it does become emergent. You wonder why they havent eaten, are having behaviors, or are vomiting. DUH. I am one of "those nurses" who are liberal with the prns. Not because I want to, but because I have to. I totally wouldn't mind someone giving a prn before the change of shift...just as long as they tell me or the CNA.

In normal situations, I try to go with when the pt want the prn.

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