Poop Protocol

[MrsChiefofControl]

The floor I work on is pushing to start bowel regiment on day 2... and for the overnight crew that really means day 1 and I think its just crazy! I don't really think it appropriate to call the covering MD about poop meds in the middle of the night, since :

1. They cover the entire hospital for the night.

2. People do not usually have a BM in the middle of the night.

3. We are trying to promote rest

4. Some people just plain do not have a BM every day.

I realize it is important to make sure our patients our having regular BMs and there needs to be some sort of accountability, but really?

Am I crazy or is it the protocol?

[cleback]

So they can't start it day 2 AM and have providers order the prns per protocol beforehand? Any protocol should be also approved by providers. I'm sure they don't want to be inundated with calls for stool softeners.

I guess I should say that our surgical patients have bowel regimens scheduled during the day, starting day 1 or 2 (depending on the service). So I think it's possible to work it out sensibly.

[MrsChiefofControl]

When I started everyone had PRN orders, but now not so much. It makes sense to me to start day 2 in the morning when the primary providers are there, but then it is "passing the buck".

[cleback]

When I started everyone had PRN orders, but now not so much. It makes sense to me to start day 2 in the morning when the primary providers are there, but then it is "passing the buck".

That's crazy to think that's "passing the buck." Why did prns stop being ordered? I feel like an interdisciplinary approach would be key for you... at least it would prevent day shifters from asking you to call docs in the wee hours of the morning for a bowel regimen.

[Nonyvole, BSN, RN]

These are post-op patients, I'm guessing.

Instead of setting up the habit of calling the on-call overnight doctor about every little thing, maybe it would be worth having a sit-down with the surgeons about having a standard set of post-op protocols in place. So when they're transferred from the PACU, there are already orders in place saying "POD #2, start bowel regimen" and have medication orders in place.

And if they did have those sorts of things in place, and have stopped it, I would then suggest having a sit-down and asking why they stopped.

(I will admit to being spoiled - my post-op patients are all covered by residents and there is a very good back-and-forth between the physicians and the nurses.)

[beekee]

When assessing your patients before they fall asleep, ask them if they'd like to be woken up for bowel meds if they don't have a BM by x AM. They will most likely refuse, then you can report off that you didn't page the on call because patient refused.