Policy Manual sample

MDT Home Health Care Agency, Inc. 125 TEMPERATURE-RECTAL PURPOSE: Rectal temperatures are taken on clients as ordered by the physician. RESPONSIBLE PERSONNEL: RN, LPN, HHA EQUIPMENT: Rectal thermometer, lubricant, gloves, alcohol preps SPECIAL CONSIDERATIONS: Refrain from taking rectal temperature on any client who: * has had rectal surgery * has diarrhea * has rectal disease * has an impaction PROCEDURE: 1. Wash your hands. 2. Explain procedure to patient. 3. Provide client with privacy. 4. Place the client in a comfortable side position with the knees flexed to the chest; drape the client. 5. Put on gloves. 6. If rectal glass thermometer displays a temperature greater than 97 degrees -F., shake the mercury level down below that figure. 7. Apply lubricant to rectal glass thermometer's tip. If using the electronic digital thermometer, apply the protective probe cover and apply lubricant at the tip. 8. Insert rectal thermometer past client's anal sphincter 1-1/2" for an adult, 1/2" for a child; hold it in place for 3 minutes. 9. Release client's buttocks so they relax into normal position. Patient must not be left alone during the procedure. 10. Remove rectal thermometer from client's anal sphincter after 3 minutes when using the glass thermometer. Digital thermometer will alert when complete. 11. Wipe rectal thermometer off with tissue moving from the handle to the mercury bulb end using a firm, twisting motion and read the thermometer's mercury level. 12. Shake the mercury level down. 13. Clean the glass thermometer with mild soap and wipe from proximal to distal end using an alcohol swab and return it to its receptacle. When using a digital thermometer, discard probe cover and clean with alcohol prep. 14. Wipe client's anal sphincter with tissue. 15. Remove and discard disposable gloves. 16. Assist client with comfort measures. 17. Wash hands. DOCUMENTATION: Document results on visit note. If action is indicated, document follow-up/notification of clinical manager and/or physician.