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Discussion

did I act incorrectly>

So I had this patient that was incontinent of bowel and bedbound, who had not had a bowel movement in a few days. He had received a suppository from the day shift nurse around 1700 and the patient who was oriented x2-3 said his bottom hurt (he also had a stage 1 pressure ulcer on bottom). Since he had not had a BM family and patient were agreeable to trying an enema. I came in with the supplies to administer the enema and the patient and was preparing to administer it, only to discover that patient had already had a BM. So I obviously didn't give the enema and we just cleaned the patient up and turned him. Family came back in after we were done. I told them that since he had a BM, an enema wasn't given. I checked with patient if he was comfortable and told him I would be back a little later with his medications. As I was washing my hands family said that patient was still reporting pressure. I told the family we would come back in and check on the patient. The family complained about me bc of this. Do you think I was being negligent in not checking to see if he needed to be changed again after we had just changed him?

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    Where I have worked an MD order was needed for an enema to be administered.

    I don't think you were negligent. I do think I would have followed up with the MD.

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    What was the complaint for, specifically? I might have asked the pt if the pressure was because he felt he still needed to go more or if it was pressure from his positioning. How long was it before you went back?

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    Your facts are not entirely clear. You stated you asked if the patient was comfortable, but you don't indicate what his reply was. You stated that family reported pressure, and you said that you would be back later. Then you ask if you should have checked the patient again right after you changed him.

    I don't know if I would use the term negligent, but it does sound like the family expressed a concern that wasn't addressed. You report the patient as oriented, you certainly could have asked him what he meant by "pressure" and if he felt he needed to be checked. Also with the current climate of patient satisfaction scores etc etc, It just makes sense to address family concerns or you can count on getting complaints.

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    I wouldn't say this is negligent but as the previous poster mentioned, the details aren't clear. Day shift gave them a suppository at 1700 but what time was it when you were going to do the enema? At my facility, the protocol is to wait 12 hours and call the MD if there's still no bowel movement because there is no standing order for an enema.

    What it sounds like is the family complained because you didn't do anything when they told you that the patient was saying he felt pressure. If I had just come out of there and my patient told me he was comfortable as far as positioning, I too would not have gone back in and assured the family that he was just re-positioned. If the pressure they were referring to was because he had to "go" some more, I also would not have gone back in saying he may have some more that will be coming out. I would have assessed his bowel movement though; was it hard, was it soft, was it liquid? And then I would have seen if he maybe needs a still softener to help pass the rest.

    If what you're saying is exactly how it happened, I wouldn't say you acted incorrectly. Could they have maybe felt that you reacted with an attitude?

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