The use of standing orders and/or clinical-care pathways to
guide the nursing care of patients is a common and accepted
practice. The law does not authorize a registered nurse or licensed
practical nurse to render medical diagnosis or to prescribe
a medical plan of care.
Qualified registered nurses may implement Physician/ Nurse Practioner
standing/routine orders, including administration of medications,
for treatment of select signs and/or symptoms following nursing
assessment and nursing diagnosis. Standing orders are written
to reflect treatment of signs and symptoms, rather than a medical
diagnosis and should include parameters for the nurse to refer
and consult the Physician/Nurse Practioner. In addition, the
standing orders are officially approved by the facility medical
staff, or approved by the prescriber for the individual patient.
The physician agrees to supervise or direct the care that is
provided, in collaboration with the entire treatment team. The
case management of a patient is mainly handled by the Registered
Nurse assigned to the patient. This Registered Nurse has authority
to start Colon Irrigation in certain very specific situations
in order to mitigate injury or worsening condition from an existing
condition.
Patients experience many common problems and symptoms which
are treated in routine ways. Because the symptoms are so common,
and the interventions used to treat these symptoms are used
over and over again, the Registered Nurse is able to recognize
which interventions fit the conditions specified in the Colon
Irrigation Standing Orders and which the physician has approved.
The use of Standing Orders allows the nurses to intervene immediately
when symptoms arise and helps to assure quality care for the
patient. It also frees up the physician to see patients in the
normal course of his or her medical practice without literally
hundreds of calls each day for routine medical orders which
he has already specified in the Standing Orders.
Even though the Standing Orders are started by the licensed
nurses caring for the patient, the physician is notified in
writing that these interventions have been started. The physician
is not normally called day after day for routine orders. Many
of the orders are started by Standing Order and written notification
is sent to the physician for his or her signature. The physician
is not involved so much on a daily basis, unless he or she chooses
to remain that involved. In the situation where the Standing
Orders do not address the specific problem which is occurring,
then the licensed nurse will call the physician for specific
orders. The nurse will also call and consult with the physician
for new orders if the interventions prescribed by Standing Order
are not effective.
Purpose:
Colon Irrigation shall be performed with authorization from
Standing Orders when worsening patient symptoms can cause injury
or worsen existing injury to digestive system. Such symptoms
warranting Colon Irrigation are as follows: when patient has
consumed a recent diet high in meats, cheeses and soft carbohydrates
with little or no fiber and has a history of constipation; or
has recent history of having a bowel movements of fewer than
three times per week; or describes having stools that are hard,
dry or small in size; or finds it painful to have a bowel movement;
or are experience straining, bloating, and the sensation of
a full bowel after a bowel movement.
OR
When a patient has scheduled a radiological or endoscopic exam
requiring bowel evacuation within 48 hours.
Safety Parameters:
Patient must be in satisfactory physical and emotional condition
to tolerate procedure as demonstrated by:
Blood Pressure: Systolic 100-150, Diastolic 60-100; Heart Rate:
55-100; Lung Sounds: Clear; SpO2: > 95%; Level of Consciousness:
Alert & Oriented X 3; Bowel Sounds: X 4 Quadrants; Patient
has no known history of Sexual Abuse (PTSD) that might cause
further emotional trauma from Colon Irrigation procedure.
Contraindications: (disease states that prohibit colon irrigation
procedure)
DOES PATIENT HAVE:
severe abdominal pain in area of sigmoid colon YES / NO | noticable
blood in feces YES / NO | congestive heart failure YES / NO
| diverticulitis YES / NO | ulcerative colitis YES / NO | Crohn's
disease YES / NO | severe or internal hemorrhoids YES / NO |
tumors in the rectum or colon YES / NO | intestinal perforation
YES / NO | carcinoma of the rectum YES / NO | fissures or fistula
YES / NO | severe hemorrhoids YES / NO | abdominal hernia YES
/ NO | renal insufficiency YES / NO | recent colon or rectal
surgery YES / NO | cirrhosis of the liver YES / NO | and first
and last trimester of pregnancy YES / NO | ALL CURRENT CONDITIONS
SHOULD GIVE RISE TO CONCERN & PATIENT SHOULD HAVE PHYSICIAN
APPROVAL TO HAVE COLON IRRIGATION TREATMENT- STANDING ORDERS
DO NOT APPLY AND CAN NOT BE USED TO AUTHORIZE COLON IRRIGATION
IN THESE INSTANCES
Policy:
Only Nursing/Medical Staff that has received CTNF certification
and adheres to CTNF policies and procedures including are permitted
to perform Colon Irrigation:
• “CODE OF PRACTICE FOR COLON HYDROTHERAPISTS”
• “COLON THERAPY Tx PROTOCOL”
• “CLIENT CONSCENT FORM”
• “CLIENT INTAKE EVALUATION”
This policy and procedure shall remain in effect for all patients
of _________________ until rescinded or until January 1, 2010.
Medical Director’s signature: _______________________________________
Effective date: _____________________
