Pre‐procedure

ActionRationale

1. 1.Show
   Carry out an appropriate manual handling assessment prior to commencing procedure and ensure that patient's weight does not exceed the maximum recommended for the commode (see manufacturer's guidelines).
   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).
3. 3.Show
   Wash hands and/or use an alcohol‐based handrub, and put on gloves and an apron. Take the equipment to the bedside.
   For infection prevention and control (NHS England and NHSI [161], C).

Procedure

1. 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).
2. 5.Show
   Remove the commode cover and ensure the brakes are on. Assist the patient out of the bed/chair and onto the commode.
   To ensure the patient can safely position themselves on the commode. E
3. 6.Show
   Once they are seated, ensure the patient's feet are positioned directly below their knees and flat on the floor or footplates of commode. 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 (Woodward [256], E).
4. 7.Show
   Cover the patient's knees with a towel or sheet.
   To maintain privacy and dignity (NMC [178], C).
5. 8.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) and to prevent falls.
6. 9.Show
   When the patient has finished using the commode, bring washing equipment to the bedside. Assist the patient to clean the perianal area using toilet paper and, where necessary, warm water or wipes. Apply a small amount of barrier cream to the perineal and/or buttock area if appropriate.
   Talcum powder should not be used, and 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).
7. 10.Show
   Offer a bowl of water for the patient to wash their hands.
   For infection control and patient dignity (Fraise and Bradley [81], E).
8. 11.Show
   Assist the patient to stand and walk to the bed/chair, ensuring that they are comfortably positioned. Ensure the call bell is within reach of the patient.
   For the patient's comfort. P

Post‐procedure

1. 12.Show
   Replace the cover on the commode and return it to the dirty utility (sluice) room.
   To reduce any risk of contamination or cross‐infection (Fraise and Bradley [81], E) and to avoid patient embarrassment (NMC [178], C).
2. 13.Show
   Remove the pan from underneath the commode and, where necessary, measure urine output and note characteristics and amount of faeces using the Bristol Stool Chart (see Figure 6.3).
   To monitor and evaluate the patient's elimination patterns. E
3. 14.Show
   Dispose of the contents safely and place the pan in the washer or disposal unit.
   For infection prevention and control (Fraise and Bradley [81], E).
4. 15.Show
   Clean the commode using chlorine wipes or chlorine cleaning solution according to local guidelines.
   For infection prevention and control (Fraise and Bradley [81], E).
5. 16.Show
   Remove disposable apron and gloves. Wash hands using bactericidal soap and water.
   For infection control (NHS England and NHSI [161], C).
6. 17.Show
   Record any urine output and/or bowel action in patient's documentation.
   To maintain accurate documentation (NMC [178], C).