obtaining orders before manual disimpaction

jmgrn65, RN · Aug 30, 2005

I know this is not a pleasant subject. I have questioned whether it is legal to manually disimpact a patient without a physician's order in Ohio. Can anyone give me some feedback on this? Sorry for the unpleasant subject!

I have never have gotten an order or heard of any my fellow nurses getting an order. Our doctors would laugh at us if we asked for an order.

unknown99, BSN, RN · Aug 30, 2005

I have never gotten an order to do so unless there was an increased risk for bleeding or the vagal response, such as in cardiac problems or liver problems.

babsberry1958 · Aug 30, 2005

I have never gotten an order to do so unless there was an increased risk for bleeding or the vagal response, such as in cardiac problems or liver problems.

THANKS FOR THE RESPONSE. I guess thats where the problem is. The nurse performing this didn't take into account the patients fragile condition. thank you!

ohioRN07 · Jun 13, 2007

When I was doing my ED rotation/preceptorship, a doc gave a verbal to disimpact. I was the student. Immediately all 6 RNs in the ED told me NOT to do it and refuse. It is invasive with risk of vagal response and perforation. The charge nurse reminded the doctor it is not within the RN scope of practice and we did find it in the facility policy manual. Of course an order for an enema immediately followed.

caliotter3 · Jun 13, 2007

In all my years working in LTC facilities I don't recall ever seeing an order for this procedure. I can tell you one story about this. It wasn't funny then, and is not funny now. I needed to approach a lady who needed this. She didn't speak a word of English and for some strange reason there was nobody around who could translate. She did a pretty good job of letting me know that she refused to be treated as well as refusing to take all laxatives ordered for her. I didn't know she had such a mean streak. I just ended up charting it all. Don't recall how anybody got her to do her business without ending up in the hospital.

txspadequeenRN, BSN, RN · Jun 13, 2007

ive always had standing orders for this, but even if i didn't i don't think id be calling...

caroladybelle, BSN, RN · Jun 13, 2007

When I was doing my ED rotation/preceptorship, a doc gave a verbal to disimpact. I was the student. Immediately all 6 RNs in the ED told me NOT to do it and refuse. It is invasive with risk of vagal response and perforation. The charge nurse reminded the doctor it is not within the RN scope of practice and we did find it in the facility policy manual. Of course an order for an enema immediately followed.

I work onco/hemo, and most places that I have been, require an order from the MD for disimpaction. The reason....most of our patients have critically low platelet or WBC counts.

In at least two teaching facilities, the intern was required to do it, at least on BMT. But given our standing orders, it was rare - lots of stool softeners and the effects of GVHD/Chemo.

psalm, RN · Jun 13, 2007

Actually, we can't call it impaction. I would chart "manually extracted xx amount of hard, dry stool"..when I had the order...and pt. condition was okay for it.