Failure to Follow Professional Standards in Rectal Medication Administration
Penalty
Summary
A registered nurse performed a digital stool dis-impaction procedure on a resident without a physician's order, which is not in accordance with professional standards of practice. The nurse inserted a rectal suppository and manipulated her finger inside the resident's rectum for several minutes, despite the resident expressing pain and asking for the procedure to stop. The nurse stated she was attempting to break up stool to allow the suppository to dissolve, and removed some stool during the process. The resident was prescribed a rectal suppository as needed for constipation, but there was no order for digital dis-impaction. The resident, who had a history of post laminectomy syndrome and constipation, reported feeling violated, embarrassed, and traumatized by the procedure. The resident's cognitive skills for daily decision-making were intact at the time of the incident. Witnesses, including a certified nursing assistant, confirmed that the procedure took significantly longer than usual and that the resident was visibly upset afterward. The resident later reported ongoing psychological distress, including nightmares and feeling unsafe in the facility. A review of facility records revealed that there was no documented competency or specific training for licensed nursing staff regarding rectal suppository administration or digital stool dis-impaction. The facility lacked a policy on digital dis-impaction, and staff interviews indicated inconsistent understanding of the correct procedures and requirements for physician orders. The facility's policy on rectal medication administration did not address digital dis-impaction, and the nurse involved believed such procedures did not require a physician's order.