RE: Fecal Impaction - Digital Manual Extraction

[Holly McGran]

I don't know about any other states - but if you read the CT Nurse Practice Act there is no way you can extrapulte from that if a manual removal of stool is within the scope of the nurse. I think the main reason the deficiency was given was because of the negative outcome that occurred in Heidi's case. Unfortunately a negative outcome can occur with many things we do- that does not mean we stop doing them and I am not so sure that an MD order would have prevented the deficiency - it was the negative outcome that resulted in the deficiency-  just my opinion. Risk management becomes a major factor in this issue. Holly McGran MSN RN  From: Faye Jones [mailto:[EMAIL PROTECTED] Sent: Friday, March 26, 2004 11:07 AM To: [EMAIL PROTECTED] Subject: RE: Fecal Impaction - Digital Manual Extraction Oh my!  Does anyone know about the legal aspects r/t NYS?  I know the surveyors have known we have done manual removals and we haven’t been cited but ????? Faye J.   -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Heidi Ebertowski Sent: Friday, March 26, 2004 9:16 AM To: [EMAIL PROTECTED] Subject: RE: Fecal Impaction - Digital Manual Extraction   They gave us a level g for Quality of Care-F309.  They felt that we caused the resident unnecessary pain and harm by performing the digital removal of stool.  The resident was end of life.  Poor p.o. intake and had not had a b.m. for 3 days.  The nurse took it apon herself to do a rectal check and then proceeded to remove the stool and the resident did have discomfort as witnessed by the surveyor.  They also tied this into f281—professional standards of care. Since all this, we have it as a policy to notify the m.d. 1st and then do as instructed. There was also a law suit that occurred in the state of North Dakota that resulted from a nurse who did digital removal of stool on a resident.  That resident ended up with a fissure to the rectum which then became gangrenous and the resident ended up dying as a result.  The nurse was found guilty.  So I guess to stay on the safe side we try to cover all our basis by getting back up from the m.d.   Heidi Ebertowski,R.N. MDS Care Coordinator Valley Memorial Homes Grand Forks, ND (701)787-7937   fax (701)787-7901 Confidentiality Statement: This message is intended for the sole use of the individual and entity to whom it is addressed, and may contain information that is privileged,confidential and exempt from disclosure under applicable law.  If you are not the intended addressee,nor authorized to receive for the intended addressee,you are hereby notified that you may not use,copy,disclose or distribute to anyone the message or any information contained in the message.  If you have received this message in error,please immediately advise the sender by reply email and delete the message.  Thank you. -----Original Message----- From: Holly McGran [mailto:[EMAIL PROTECTED] Sent: Friday, March 26, 2004 8:00 AM To: [EMAIL PROTECTED] Subject: RE: Fecal Impaction - Digital Manual Extraction   We have been doing for years.... What did the deficiency come under? Where is this standard of practice written - reference? Thank you in advance.   From: Heidi Ebertowski [mailto:[EMAIL PROTECTED] Sent: Friday, March 26, 2004 8:49 AM To: [EMAIL PROTECTED] Subject: RE: Fecal Impaction - Digital Manual Extraction It does need to be ordered by a physician.  It is not within a nurses scope.  We got a deficiency related to this about 2 years ago.  A surveyor witnessed a nurse do this.  You can perform dig stim as a nurse but not digital manual extraction unless ordered to do so.     Heidi Ebertowski,R.N. MDS Care Coordinator Valley Memorial Homes Grand Forks, ND (701)787-7937   fax (701)787-7901 Confidentiality Statement: This message is intended for the sole use of the individual and entity to whom it is addressed, and may contain information that is privileged,confidential and exempt from disclosure under applicable law.  If you are not the intended addressee,nor authorized to receive for the intended addressee,you are hereby notified that you may not use,copy,disclose or distribute to anyone the message or any information contained in the message.  If you have received this message in error,please immediately advise the sender by reply email and delete the message.  Thank you. -----Original Message----- From: Kathy Archibald [mailto:[EMAIL PROTECTED] Sent: Thursday, March 25, 2004 4:42 PM To: [EMAIL PROTECTED] Subject: Fecal Impaction - Digital Manual Extraction   Can anyone give me their opinion or knowledge whether doing a manual extraction is within a nurse's scope without a physician's order? Kathy Archibald RN Living Center Supervisor FAX 1-208-547-2790 Voice 1-208-547-2771 email [EMAIL PROTECTED] Important Notice:  This communication, including any attachments, may contain information that may be confidential or privileged and is intended solely for the entity or individual to whom it is addressed.  If you are NOT the intended recipient, you must delete this message and attachments and are hereby notified that any disclosure, copying, or distribution of this message is strictly prohibited.  Nothing in this email, including any attachment, is to be a legally binding signature.