Policy Manual sample

MDT Home Health Care Agency, Inc. 43 FECAL IMPACTION – REMOVAL PURPOSE: Manual removal of a fecal impaction is in accordance with the physician's plan of care so that discomfort is relieved and the normal pattern of defecation is reestablished. It may be contraindicated in the presence of severe cardiac conditions, severe medical conditions which predispose the patient to easy bleeding, and following recent colorectal or gynecological surgery. It may be contraindicated following pelvic irradiation and during pregnancy. If the patient complains of severe pain, shows symptoms of extreme exhaustion, or begins to bleed, the procedure should be interrupted and the physician notified. The finger used to break up the fecal impaction should be well lubricated with a water soluble lubricant so that delicate rectal tissue will not be irritated or traumatized. RESPONSIBLE PERSONNEL: RN, LPN EQUIPMENT: Gloves, Moisture barrier ointment, Lubricant, Chux pads, soap, water, towel, washcloth, tissue SPECIAL CONSIDERATIONS: It is important to remember that fecal impactions can usually be prevented if a bowel care regimen including ambulation, exercise, adequate nutrition and fluid intake is balanced with the use of stool softeners and laxatives as approved by the physician. A history of bowel habits prior to illness will assist in making a judgment regarding the need for intervention. The home health care team member should ask specifically when the last bowel movement occurred so that intervention can be timely. Symptoms which may indicate the presence of a fecal impaction include the absence of stool, oozing of diarrheal stool or fecal liquid from the rectum, listlessness, pain, or a persistent, non-productive urge to defecate. PROCEDURE: 1. Explain procedure to patient and assemble equipment. 2. Wash hands, don gloves. 3. Remove pillow from underneath patient's head and turn patient to left lateral position. Flex knees. 4. Place Chux beneath buttocks and drape so that only the rectal area is exposed. 5. Lubricate index finger of the dominant hand. 6. Gently insert index finger into rectum. 7. Once the mass is located, massage around the periphery. Instruct patient to take slow, deep breaths during the procedure. 8. Insert the finger into the center of the mass. 9. Remove the feces by moving small amounts down to the rectum. 10. Continue until as much feces as possible has been removed. Assess patient’s tolerance to the procedure and allow for rest periods as needed. 11. Clean the patient and assist him to comfortable position. Remove gloves, wash hands. 12. Instruct regarding diet, exercise, fluid intake and appropriate medication regimen as