Proper way to give suppositories

[agldragonRN]

hello allnurses!

i need your opinion on something.

i am an lpn in ltc. we have several floors or units in my building. one floor is being renovated so that floor is dispersing its patients to any floor that has available rooms. we received one female patient from that floor a couple of weeks ago and she is alert and oriented x 3 with physical deformities so she is unable to care for herself. she is not ambulatory but she can propel herself with one arm in the wheel chair.

anyway, she gets dulcolax suppository every three days and she likes to get it while she is sitting on the toilet chair. mind you, the toilet is low and she wants me to bend over (i'm 6 feet tall) and insert the ducolax without seeing the rectum. so the first day she was transferred to my floor, i did it her way because that's how she's been getting it from her old floor. it was very difficult for me because i had to feel for her rectum first because i could not see anything even with me bending and my face was so close to her crotch because the toilet is low and no extra room so i did it through her front. i told her afterwards that it was difficult for me and bending that low was not good for my back.

the next time i gave it to her i asked her to stand for me and hold on to the rails and i will insert the dulcolax that way. the c.n.a. was there supporting her back. i inserted it quickly and put her back in the toilet chair. she resisted at first but i've been doing it that way ever since.

i thought everything was fine but today the nurse manager on her old floor came up to my floor and spoke to my nurse manager and said the patient came to her and complained that we changed her routines. my nurse manager said to her that she agreed with me asking the pt to stand up. then the old nurse manager said she will go to the don and report this. my nurse manager said ok report.

so the old nurse manager came back and said to my nurse manager that our don said we have to follow what ever the pt wants. so when i came to work at 3pm, my nurse manager told me what the don said per the other nurse manager.

i told her i totally disagree with that and i am not going to break my back and plus suppository should be given when the pt is in bed. but no the pt wants it when she's on the toilet and exactly at 5pm. my nurse manager said she agrees with me and i should write a memo to the don.

then a couple of hours later i saw the old nurse manager and asked her what the don exactly said. she said if we have a problem go see the administration. so i explained to her i am tall and it was difficult for me to bend and i needed to see the orifice so i can insert the med properly. she said i did not have to look at the orifice and “just insert” it. she also said her staff did not have a problem when this pt was on her floor and why are we having problem following patient's routines.

so my questions to you guys, is it worth fighting this? should i just sacrifice my back to make the pt happy especially the don said we have to follow what the pt wants? is there a better way of giving suppository? i was taught in lpn school that i should be able to see the orifice before inserting suppository and proper body mechanics dictates that suppository should be given when the pt is in bed?

am i wrong?

thanks for your advice and for reading my long post!

angel

[MedSurgeMess]

. We took it to our nurse manager who just laughed and said to do our regular nursing care and let the wife take care of her "list of demands".

Yay!!!! good for her, for standing up for the ridiculous list of customer service junk many of us do on a daily basis

[RedhairedNurse, BSN, RN]

Why would someone want a suppository inserted while they're sitting on the commode? Doesn't make sense to me.

It seems like the suppository would just squirt out immediately, how does she hold it in?

Anyway, I would refuse to insert it in the way she is requesting. It's against the 'Nurse Practice Act' for us to perform or administer anything other than the way it is correctly to be done.

[leslie :-D]

except for the awkward ergonomics, i'm not understanding the big deal.

and i'm esp not understanding why/how your face is near the pt's "crotch"?

wouldn't you be standing on her side, using the closest arm/hand to palpate and insert?

and speaking of palpation, what is wrong with doing it blindly?

it's not anatomically challenging to find the orifice.

fwiw, elderly often are prone to bowel/constipation problems, so when they find a routine that works, they stick with it.

i like the suggestion about sticking to the p&p manual (if it's even addressed).

but other than that, keep your face away from her crotch and see if you can insert it before she sits down on the toilet.

hope everything comes out ok.

heh.

leslie

[leslie :-D]

It's against the 'Nurse Practice Act' for us to perform or administer anything other than the way it is correctly to be done.

now, that's a stretch.

it's not as if he's inserting it up her nose.

leslie

[agldragonRN]

except for the awkward ergonomics, i'm not understanding the big deal.

and i'm esp not understanding why/how your face is near the pt's "crotch"?

wouldn't you be standing on her side, using the closest arm/hand to palpate and insert?

and speaking of palpation, what is wrong with doing it blindly?

it's not anatomically challenging to find the orifice.

fwiw, elderly often are prone to bowel/constipation problems, so when they find a routine that works, they stick with it.

i like the suggestion about sticking to the p&p manual (if it's even addressed).

but other than that, keep your face away from her crotch and see if you can insert it before she sits down on the toilet.

hope everything comes out ok.

heh.

leslie

she is in the toilet (with toilet chair) in a small confined bathroom, no space for me to go on either side or the back, only through front. i am 6 feet tall and the toilet is low.

she likes the suppository to be inserted when she is sitting already on the toilet chair so inserting it before she sits down is deviating from her "routines".

i know where the orifice is. i took ap i & ii and i have my own as well. the problem is me bending so low and my face near her crotch and blindly inserting it.

[agldragonRN]

why would someone want a suppository inserted while they're sitting on the commode? doesn't make sense to me.

it seems like the suppository would just squirt out immediately, how does she hold it in?

anyway, i would refuse to insert it in the way she is requesting. it's against the 'nurse practice act' for us to perform or administer anything other than the way it is correctly to be done.

i heard from agency nurses that come to my floor who took care of this pt previously that sometimes the dulcolax would squirt out as soon as you put it and she would ask you to insert a new one.

[leslie :-D]

ah, ok...

then yes, i would refuse just by reason of its inappropriateness.

esp being different genders.

heck, i would never insert it on a male pt, from a frontal position.

never.

seriously, see if it's addressed in your p&p.

or, if the toilet is movable, move it elsewhere.

eek.

leslie

[Medic/Nurse, BSN, RN]

I find it kinda funny that I am posting to a suppository question - as, thankfully, air transport sort of eliminates the possibility of ever using them - but, strangely enough we have some tylenol ones on the helo.

I think this is a simple issue of medication administration. Follow the P & P to the letter and then Standards of Administration to the letter. (I would think that the "bearing down" that takes place on the toilet alone would make that position for insertion of a medication that should be retained for a certain time - UNSUITABLE). Anyway, unless you can find a guide to administration that details this "position" as suitable and the P & P do not detail the same - then just follow the written rules.

As for the position issues that you note due to your height - well, those are real. I am concerned that you would not have a basis (or they will have a defense) for any resulting back injury that you may sustain while doing "anything the patient wants, anyway they want" - all the while the administration notes "informally" (as in tells you) for you to - just do it!

The biggest issue that I see - is if you hurt your back they can note that you were not administrating the medication in the proper position, not using proper body mechanics. You lose. The defense that they "said" just do whatever - others do it, you should too - is absurd.

As for the poster that notes a psych issue - that may be a component, or it could be less the suppository that is making her go as it is stimulation of the anal area while on the toilet (that statement seems disturbing once I typed it :eek ). Momma cats lick kitten bottoms to stimulate them to poo so that is my mindset - not that the mental image is improving. :eek:

I say - FOLLOW THE RULES.

IF you were to have an injury (or exposure due to "crotch" vicinity - this is getting worse, sorrry) the only thing that will save you is that you were hurt despite following good positioning mechanics and following some standard of care.

Good Luck.

[RedhairedNurse, BSN, RN]

now, that's a stretch.

it's not as if he's inserting it up her nose.

leslie

Thats being a little sarcastic, Leslie, please keep you sarcasm to yourself.

I didn't say it's going up her nose. Give respect please.

To the OP -- I've seen many women that

have a crazy amount of hemorrhoids and may even possibly have a fistula or two back there.

I'm going to see where I'm inserting a suppository before I attempt to go in blindly. Or at least get

an idea of what their anatomy is like back there before I start sticking things where they

possibly shouldn't go.

Have a nice day. That goes for you too, Leslie. ; - D

[caliotter3]

I injured my back while doing a transfer of a patient one time and my employer saw to it that I did not get worker's compensation for the medical care I required. I was following proper procedure. I am also concerned about the consequences of you hurting your back. I would refuse to do this. They can not force you to injure yourself by not following accepted procedure.

[XB9S, BSN, MSN, EdD, RN, APN]

Could I please remind all posters to refrain from posting off topic. Let's keep on track and keep the personal comments off the board

thank you

[sharpeimom]

would she perhaps consider using a bedside commode on suppository days? by positioning the potty chair so you had adequate room to work in, you would eliminate (no pun intended...) the groping around from the front because you had enough room to work from the side of the chair.

kathy

shar pei mom:paw::paw: