Order to disimpact?

Isabelle49 · Mar 5, 2011

Would you generally say that in home health, as in most other settings, you'd need to get an order from the MD before digitally disimpacting a patient? It seems to qualify under invasive procedure to me, but I know one nurse who does it without getting an order first. She just uses her "best judgment".
Order before disimpacting or no?

Yes, you certainly do need an order to perform this procedure. You also have to have experience doing the procedure and have an understanding of complications, i.e., the potential for bradycardia due to vagal stimulation.

tinderbox · Mar 5, 2011

Isabelle49,

That's what I figured, but I'm still learning the vague (and not so vague) differences between hospital nursing and home health. This one, though, just seemed like something too invasive to be doing just on nurses' "best judgment"!

KateRN1 · Mar 6, 2011

Really, there is almost nothing in home health that doesn't need an order. We even need an order to perform pulse oximetry.

systoly · Mar 9, 2011

Isabelle49,
That's what I figured, but I'm still learning the vague (and not so vague) differences between hospital nursing and home health. This one, though, just seemed like something too invasive to be doing just on nurses' "best judgment"!

From a legal point of view, there are no differences. No order means no can do. The family has no obligation to obtain an order before taking interventions, but it is up to us to make sure they have been informed and educated. In this particular case, I'd strongly discourage anybody to do this without order. First, even if it's after hours, an order can be obtained, and second, there needs to be some follow up and preventive measures which require orders. I've had similar discussions with peers and heard statements such as, "I've done it for years" which is, of course, completely invalid.