Pre‐procedure

ActionRationale

1. 1.Show
   Carry out an appropriate manual handling assessment prior to commencing procedure and establish whether an additional nurse or equipment such as a hoist is necessary.
   To maintain a safe environment. E
2. 2.Show
   Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [178], C).

Procedure

1. 3.Show
   Take the equipment to the bedside. Wash hands and put on gloves and apron.
   To ensure the procedure is as clean as possible and minimize the risk of spreading infection (NHS England and NHSI [161], C).
2. 4.Show
   Close the door or draw the curtains around the patient's bed area.
   To maintain privacy and dignity and avoid any unnecessary embarrassment for the patient (NMC [178], C).
3. 5.Show
   Remove the bedclothes and, providing there are no contraindications (e.g. if patient is on flat bedrest), assist the patient into an upright sitting position.
   An upright, ‘crouch‐like’ posture is considered anatomically correct for defaecation. Poor posture adopted while using a bedpan has been shown to cause extreme straining during defaecation. Patients should therefore be supported with pillows in order to achieve an upright position on the bedpan (Woodward [256], E).
4. 6.Show
   Ask the patient to raise their hips and buttocks, and insert the bedpan beneath the patient's pelvis, ensuring that the wide end of the bedpan is between the legs and the narrow end is beneath the buttocks.
   A slipper bedpan provides more comfort for a patient who is unable to sit upright on a conventional bedpan (Nicol [176], E).
5. 7.Show
   Offer the patient the use of pillows and encourage them to lean forward slightly if possible.
   To provide support and optimize positioning for defaecation (Woodward [256], E).
6. 8.Show
   Once the patient is on the bedpan, encourage them to move their legs slightly apart and check to ensure that their positioning is correct.
   To avoid any spillage onto the bedclothes and reduce the risk of contamination and cross‐infection. E
7. 9.Show
   Cover the patient's legs with a sheet.
   To maintain privacy and dignity (NMC [178], C).
8. 10.Show
   Ensure that toilet paper and a call bell are within the patient's reach and leave the patient, but remain nearby.
   To maintain privacy and dignity (NMC [178], C).
9. 11.Show
   When the patient has finished using the bedpan, remove it, replace the paper cover and bring washing equipment to the bedside. Assist the patient to clean the perianal area. Apply a small amount of barrier cream to the perineal and/or buttock area if appropriate.
   Talcum powder should not be used. Barrier creams should be applied sparingly and gently layered on in the direction of the hair growth rather than rubbed into the skin (Le Lievre [123], E).
10. 12.Show
    Offer a bowl of water or moistened wipes for the patient to clean their hands.
    For infection prevention and control, and for the patient's comfort (Fraise and Bradley [81], E).
11. 13.Show
    Ensure the bedclothes are clean, straighten the sheets and the rearrange pillows, and assist the patient into a comfortable position. Ensure the call bell is within reach of the patient.
    For the patient's comfort. P
12. 14.Show
    Take the bedpan to the dirty utility (sluice) room and, where necessary, measure urine output and note characteristics and amount of faeces using the Bristol Stool Chart (Figure 6.3).
    To monitor and evaluate the patient's elimination patterns. E

Post‐procedure

1. 15.Show
   Dispose of the contents safely and place the bedpan in the washer or disposal unit.
   For infection prevention and control (Fraise and Bradley [81], E).
2. 16.Show
   Remove disposable apron and gloves. Wash hands using soap and water and/or alcohol‐based handrub.
   For infection prevention and control (NHS England and NHSI [161], C).
3. 17.Show
   Record any urine output and/or bowel action in the patient's documentation.
   To maintain accurate documentation (NMC [178], C).