I use lots of lubricant, which I try get all along the edges of the stoool i feel. I wear 2 gloves (nothing worse than finding my glove broke), very gently with my index finger I break up the stool and pull it out, being carefull not to disrupt the tissue of the rectal area. Can be a very tedious job I find, because I am careful and because I work in a nursing home and have some demented people that resisit it, but it is better then having that same resident impacted.
We don't require a doctor's order to digitally remove BM, but we do chart what we did and what was removed (color, consistancy, resident tolerance). I don't know about a post surgical telemetry patient as far as orders go.