Sentinel event

[littlebit1]

If a fecal impaction is considered a "sentinel event" does that mean you have to self report?

[Blee O'Myacin, BSN, RN]

If a fecal impaction is considered a "sentinel event" does that mean you have to self report?

http://www.jointcommission.org/SentinelEvents/

According to the joint commission definition, the sentinel event occurs when there is permanent loss of life or function whether physical or psychological.

"

The terms “sentinel event” and “medical error” are not synonymous; not all sentinel events occur because of an error and not all errors result in sentinel events. " - quote from the cited website.

So if the patient died from a toxic megacolon, then I'd consider it sentinel since there was a lot of time were it could have been picked up. A straightforward fecal impaction that is cleared by obtaining a doc's order for a laxative (or has to be manually disimpacted, etc.) is not, by definition, a sentinel event. Check your policy and procedure for your facility to see what has to be done paperwork wise. Does your facility specify "fecal impaction" as a sentinel event?

Reporting a sentinel event doesn't mean that you are placing blame. At least in theory.

Blee

[CapeCodMermaid, RN]

If it is truly an impaction, it won't be cleared by a suppository or enema....and yes, you should report it if it caused a trip to the hospital.

[littlebit1]

Forgive me if my question seems ignornant however new in the LTC area-

if the fecal impaction required an enema however the resident was transferred to the hospital with the dx of fecal impaction among other dx. The impaction was relieved with an enema -do you need to self report to the state?

Some nurses are saying "we need to report to DIA" others are saying "no' - we spent hours trying to look up the answer but could not find it.

[debRN0417]

If it is truly an impaction, it won't be cleared by a suppository or enema....and yes, you should report it if it caused a trip to the hospital.

That is true. Most residents who go to the ER come back with a diagnosis of a UTI, dehydration, or a fecal impaction. You have to watch those diagnoses....most of the time they are not factual...I am not saying that the ER mis-diagnoses, but we all know about that....CapeCodMermaid is right....no true impaction is taken care of by enemas or suppositories, but if you have gotten that diagnoses, then you need to investigate to unsubstantiate the "sentinel event".

[PsychNurseWannaBe, BSN, RN]

Great thread: digital impaction. I was searching for digital stool removal and stumbled on this. Does this have to be MD ordered? If a resident is having a hard time expelling their BM; do I stop and call MD or is there contigent on what state you live in?

Any tips or tricks to performing it? I ask because I am a guy with rather large hands and the one lady I was trying to help said,..."but you have large hands"... I lubed up with four or five packets. How far do you go up? I got a lot out, but the remaining was pretty high up there. I thought about a supp, but another nurse mentioned enema.

The stool was soft, not hard. But she just has problems expelling stool - on occasion, she is also obsessed with bowel movements. Even with DSS, Senna S or Bisacodyl PO. I actually held her stool softener today because she was having diarrhea and when I looked because she said she still felt full I was surprised to see stool. I tried very hard to reassure her because if she had her way, she would swing between MOM and then Immodium and then use MOM and become upset with her BM and want Immodium. She is rather complex, lots of anxiety with OCD.

Thoughts? How long do you attempt it for? Dietary informed and has increased her fiber including oatmeal and prunes.

Do you do it in the bathroom or in the bed? I couldn't get her in bed. Oh it was kinda of horrible because she kept pushing VERY hard and I reminded her several times to stop pushing because I was worried about vaso-vagal. I mean she just gripped the toilet seat handles and beared down. I think she did this so much that she could no longer control her sphincter or lower rectal muscles d/t over pushing.

[CapeCodMermaid, RN]

You need an order to do a digital disimpaction precisely because of the possibility of vaso-vagal. Probably easier to do it in the bed but at least on the toilet or commode there is the semblance of having a bm the normal way. We don't ever disimpact anymore. We try to pay enough attention before it becomes a problem....or....fleets.