To digitally disempact or not?

Posted

Specializes in MED/SURG STROKE UNIT, LTC SUPER., IMU. Has 10 years experience.

What is your hospital's policy on digital disempaction? Do you need a MD order or is there any policy at all? We have no policy, according to the charge nurse and so I did disempact a pt yesterday with success so the pt could go ahead and be discharged, but it got me to thinking what other facilities have in place. I know in some nursing homes it is a big NO NO now.

jhanes

62 Posts

"in some nursing homes it is a big NO NO now. " That's because we need tort reform in America. Nursing homes are petrified of being sued because of the 1:Gazillion chance someone might be harmed by digital disimpaction and they get sued. As a result, suffering elderly patients get shuttled back and forth between the SNF and the ER, until they are dehydrated, perforate or simply someone relents and disimpacts them. I see it all of the time.

merlee

Has 36 years experience. 1,246 Posts

You need a dr's order. And lots of lube. Maybe a mineral oil enema first.

MisMatch, LPN

Specializes in geriatrics. Has 16 years experience. 146 Posts

I work in a nursing home which allows us to digitally disempact. My experience has been that nursing homes are bowel obsessed. Residents are all on bowel meds, each BM is recorded, reports generated daily, assessments done, fluids encouraged, reports made, orders written, interventions done, reports made...until bowels have been moved. On occasion, when it is determined there is hard stool they can't push out, we go in with lots of gloves, lube and wipes or washclothes. It has instantly relieved abdominal pain so they can go to sleep (I work nights). It's not something we do often, maybe once every month or two. I can't imagine not being allowed to.

taalyn_1, CNA

Specializes in CNA. 124 Posts

My LTC facility requires the nurse to get a Doctors order for that.

lovethis

9 Posts

I work in a Rehab Hospital with SCI population which in turn equals bowel programs every evening for them!!!! Including but not limited to: digital stim, manual removal, Dulc supp, mini-enemas, Fleets, SMOGs. Oh the joys of being a bowel queen!!!

TonyaM73, ASN, RN

Specializes in MED/SURG STROKE UNIT, LTC SUPER., IMU. Has 10 years experience. 249 Posts

I know the joys!! I worked in LTC before I moved to the hospital and we would occationally have a pt that was just really stuck. I disempacted one time and then was told "we could not do that". So, when I had my pt completely ready for discharge on the med/surg floor and then she told me she just couldn't get it out...I went to the charge nurse. She stated that we didn't have any policy and that some nurses choose to disempact and some chose not to. Needless to say with how uncomfortable this pt was and then with her telling me that she has to come to the hospital every couple of months or so to get disempacted, I went ahead and did it so that she would have some relief and not have to come back for a while. It took a few enemas and several go arounds to get her cleared out, but I accuired a nick name in the process. The new nurse of only a few months on this floor is now called....."Butt digger". Lovely!

diane227, LPN, RN

Specializes in Management, Emergency, Psych, Med Surg. Has 32 years experience. 1,941 Posts

It absolutely depends on your facility and what is wrong with your patient. Some facilities require a physician order. Some do not. But you are still responsible for using sound judgment. A digital disimpaction is not without it's dangers. When you have a patient who has any history of cardiac disease or hypertension and who are on meds for those problems, it can be an issue. In addition, some patients are very sensitive and will have a hypotensive episode easily. I have had patients pass out while being given a fleets enema. When I perform a disimpaction I always monitor the patients vitals throughout the procedure just as a precaution.

MomRN0913

Specializes in ICU. 1,131 Posts

We do it all the time in our ICU. One GI Doc jokes around about his years of intense training in order to shove a finger up an a$$ and dig for crap, and here are us nurses digging for Gold. he is actually very thankful:)

ZippyGBR, BSN, RN

Specializes in Spinal Cord injuries, Emergency+EMS. 1,038 Posts

I work in a Rehab Hospital with SCI population which in turn equals bowel programs every evening for them!!!! Including but not limited to: digital stim, manual removal, Dulc supp, mini-enemas, Fleets, SMOGs. Oh the joys of being a bowel queen!!!

as nurse who works with SCI patients, the ignorance of other healthcare providers over manual evacuation is sometimes shocking , despite the existance of the NPSA alert and ther requirements that imposes on UK healthcare settings

http://www.nrls.npsa.nhs.uk/resources/?entryid45=59790&q=0%c2%acbowel%c2%ac