The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [173]
Postprocedure
17 Dispose of contents safely and place bedpan in the washer/disposal unit. For infection prevention and control (Fraise and Bradley 2009, E).
18 Remove disposable apron and gloves. Wash hands using soap and water. For infection prevention and control (Fraise and Bradley 2009, E).
19 Record any urine output/bowel action in patient’s documentation. To maintain accurate documentation (NMC 2009, C).
Procedure guideline 6.2 Commode use: assisting a patient
Essential equipment
Disposable apron and gloves
Commode with conventional bedpan inserted below seat
Toilet paper
Manual handling equipment as appropriate
Additional nurse if required
Wash bowl, warm water, disposable wipes and a towel
Preprocedure
Action Rationale
1 Carry out appropriate manual handling assessment prior to commencing procedure and ensure that patient’s weight does not exceed the maximum recommended for commode (see manufacturer’s guidelines). To maintain a safe environment. E
2 Wash hands, put on gloves and apron. For infection prevention and control (Fraise and Bradley 2009, E).
3 Take the equipment to the bedside and explain the procedure to the patient. To ensure that the patient understands the procedure and gives their valid consent (NMC 2008a, C).
Procedure
4 Close door/draw curtains around the patient’s bed area. To maintain privacy and dignity and avoid any unnecessary embarrassment for the patient (NMC 2008b, C).
5 Remove the commode cover. Assist the patient out of the bed/chair and onto the commode.
6 Ensure the patient’s feet are positioned directly below their knees and flat on the floor. The use of a small footstool and/or pillows may help to achieve a comfortable position. An upright, crouching posture is considered anatomically correct for defaecation. Pillows and a footstool can provide support and optimize positioning for defaecation (Taylor 1997, E).
7 Once the patient is on the commode, encourage them to move their legs slightly apart and check to ensure that their positioning is correct. To avoid any spillage and reduce risk of contamination and cross-infection. P
8 Cover the patient’s knees with a towel or sheet. To maintain privacy and dignity (NMC 2008b, C).
9 Ensure that toilet paper and call bell are within patient’s reach and leave the patient, but remain nearby. To maintain privacy and dignity (NMC 2008b, C).
10 When the patient has finished using the commode, bring washing equipment to the bedside. Assist patient with cleaning perianal area using toilet paper and, where necessary, warm water and soap. Apply a small amount of barrier cream to the perineal/buttock area if appropriate. Talcum powder should not be used and barrier creams should be applied sparingly, gently layered on in the direction of the hair growth rather than rubbed into the skin (Le Lievre 2002, E).
11 Offer a bowl of water for the patient to wash their hands. For infection control and patient dignity (Fraise and Bradley 2009, E).
12 Assist the patient to stand and walk to bed/chair, ensuring that they are comfortably positioned. Ensure call bell is within reach of the patient. For patient comfort. P
Postprocedure
13 Replace cover on the commode and return to the dirty utility (sluice) room. To reduce any risk of contamination or cross-infection (Fraise and Bradley 2009, E) and to avoid patient embarrassment (NMC 2008b, C).
14 Remove pan from underneath the commode and where necessary, measure urine output, and note characteristics (see Figure 6.1) and amount of faeces. To monitor and evaluate patient’s elimination patterns. E
15 Dispose of contents safely and place pan in the washer/disposal unit. For infection prevention and control (Pratt et al. 2007, C).
16 Clean commode using Actichlor plus solution.
17 Remove disposable apron and gloves. Wash hands. For infection control purposes (Fraise and Bradley 2009, E).
18 Record any urine output/bowel action in patient’s documentation. To maintain accurate documentation (NMC 2009, C).
Figure 6.1 Bristol Stool Form Chart.
Reproduced by kind permission