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

clemmm78, RN · Feb 20, 2007

delete

MS._Jen_RN, ASN, RN · Feb 20, 2007

I'm in the Rehab bussiness. We give our suppositories when it is convienent for the Pt. We try to get those who will have them as a matter of life on a schedule that will fit their home life before they go home. (ie young SCI who might look at being in the workforce who wants to poop before going to work) I has nothing to do with the oncoming shift. Now, as an eve RN, I would try not to give it toward the end of my shift r/t the Pts trying to sleep and having therepies in the AM.

~Jen

TrudyRN · Feb 20, 2007

All I know is, if I'm ever forced to live in a nursing home and someone wakes me up at the ungodly hour of 6 AM to deliver a 'silver bullet', he or she is going to be in for a bad time. How incredibly rude to schedule such an invasion so that it's most convenient for the STAFF, rather than the resident!!

Amen.

Also, back in the Dark Ages, we used to give po laxatives HS in the hospital, so they'd work by morning. I don't know about suppositories in Nursing homes but I think they should be given when best for the patient. True enough, though, what's best for the pt is to not have to lie in the results for an extended period. That probably does translate to doing it when it is best for the nursing staff. Hmm, quite a conundrum. Nothing is ever simple.

TrudyRN · Feb 20, 2007

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.
~faith,
Timothy.

Tim, it seems like a patient could get pretty plugged up by then. Please don't take offense, just my opinion.

TrudyRN · Feb 20, 2007

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.

Just FYI - Night aides have a ton of work to do - if they actually do it. They are supposed to round q2h and change and reposition every patient who can't do it for himself. They should be doing whatever VS need doing, charting, answering lights, and restocking the rooms. Then they should get up and shower and dress the 2 or 3 patients they are supposed to do that for. It's lousy for the residents who get to be forced awake so early but that should be rotated so that it isn't always the same residents. They can also help answer the phones and the doorbell. They wash IV poles and wheelchairs and there are probably other tasks I'm forgetting.

TrudyRN · Feb 20, 2007

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.

I think those nurses weren't worried about their pts' bowel troubles. Those nurses were criminally nuts!

not now, RN · Feb 20, 2007

I work LTC and bowel protocol is done on any shift, it just depends on what shift it lands on. I can't explain it well. We look at the BM book at the beginning of every shift. CNA's fill in the amount, size and consistency for each shift. The nurses sign that they've looked at it and, if a med was given, you sign out what you gave. If two days and no BM happens to land on your shift you give it.

I know for a fact that AM's give meds/suppositories at the end of their shift. I give MOM during my first med pass so hopefully they'll after dinner since it take a while for it to work in my residents. I give suppositories and enemas as soon as they are put to bed so I can see results. I work PM's.

Just the other day an nurse was telling me "Oh, you know "Mary" she's been crying all shift that she's impacted and she wants a suppository. She had a BM yesterday and I'm not giving her anything." I asked if she checked and she replied "I'm not sticking my hand in that lady's butt! That's all she wants anyway!" Granted this lady is schizophrenic, very delusional and an absolute pain to work with but I felt bad. So I said I would talk to her and check. I did and she was so impacted it was ridiculous. I gave her a suppository and the nurse said "Better you than me."

Yes I know I totally took off on a tangent but I was frustrated. Sorry!

GardenDove · Feb 20, 2007

Wow, it sounds like nurses get into real intershift power struggles over suppositories!

Roy Fokker, BSN, RN · Feb 20, 2007

I've given suppositories when I felt my patients needed 'em.

If I thought they could wait a couple hours, I'd tape that in report and also make sure I pass it along verbally to the next nurse.

My co-workers and techs are mostly a great bunch. They support me :-)

sunneeRN · Feb 20, 2007

I have to be honest, as a newer nurse, none of this ever occured to me until I read this thread. in my assessment, i ask the patient if they've moved their bowels and if they have, i dont worry about it. if they haven't for awhile, i just bring it to the doctor's attention. we usually don't have prn orders for laxatives or supps. and when they are ordered, we just give them as they are ordered, without regard to what the other shift may think. i never thought about "dumping" the work on another shift. Then again, most of our patients are post op, and dont move their bowels for several days but still, thank you for opening my eyes to the world of the rules of supps!

jimthorp · Feb 21, 2007

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?

Doesn't bother me. I'd rather deal with the poop than an obstructed bowel.

psalm, RN · Feb 21, 2007

...when i was a new nurse and working LTC we had the bowel program. Days gave MOM, if resident didn't produce by 10 PM, the nurse would have to follow up with a suppository. The deal was res. couldn't go more than 2 days without a BM.

...I was new and not used to the dementia pts...and trying so hard to keep up with the established nurses with my med pass, bowel program, the usual LTC issues with diversion, PM care, etc. (I worked 7p-7a). So when one of the little old ladies didn't want her suppository, I told her she had to have it since she didn't have a bowel movement for 2 days. She said, who said that I have to go every 2 days? and naieve me, I answered "the state of Michigan". I wish you could have seen the look on her face AND MINE when I realized how that sounded :rolleyes: