Pre‐procedure

ActionRationale

1. 1.Show
   Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed. If administering a medicated suppository, it is best to do so after the patient has emptied their bowels.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [178], C). To ensure that the active ingredients are not prevented from being absorbed by the rectal mucosa and that the suppository is not expelled before its active ingredients have been released (Moppett [150], E).
2. 2.Show
   Wash hands and/or use an alcohol‐based handrub, and apply personal protective equipment
   To ensure the procedure is as clean as possible and for infection control (NHS England and NHSI [161], C).
3. 3.Show
   Draw the curtains around the patient or close the door.
   To ensure privacy and dignity for the patient (NMC [178], C).
4. 4.Show
   Ensure that a bedpan, commode or toilet is readily available.
   In case of premature ejection of the suppository or rapid bowel evacuation following its administration. P

Procedure

1. 5.Show
   Assist the patient to lie on their left side with the knees flexed, the upper knee higher up the bed than the lower one, with the buttocks near the edge of the bed.
   This allows ease of passage of the suppository into the rectum by following the natural anatomy of the colon (Peate [193]). Flexing the knees will reduce discomfort as the suppository is passed through the anal sphincter (Peate [193], E).
2. 6.Show
   Place a disposable incontinence pad beneath the patient's hips and buttocks.
   To avoid unnecessary soiling of linen, leading to potential infection and embarrassment to the patient if the suppository is ejected prematurely or there is rapid bowel evacuation following its administration. E
3. 7.Show
   Wash hands with soap and water or use an alcohol‐based handrub and put on apron and gloves.
   For infection prevention and control (NHS England and NHSI [161], C).
4. 8.Show
   Place some lubricating jelly on a gauze square and lubricate the blunt end of the suppository if it is being used to obtain systemic action. Separate the patient's buttocks and insert the suppository blunt end first, advancing it for about 2–4 cm. Repeat this procedure if additional suppositories are to be inserted.
   Lubrication reduces surface friction and thus eases insertion of the suppository and avoids anal mucosal trauma. The suppository is more readily retained if inserted blunt end first (Abd‐el‐Maeboud et al. [2], R). The anal canal is approximately 2–3 cm long. Inserting the suppository beyond this point ensures that it will be retained (Abd‐el‐Maeboud et al. [2], R; Pegram et al. [197], E).
5. 9.Show
   Once the suppository has been inserted, clean any excess lubricating jelly from the patient's perineal and perianal areas using gauze squares.
   To ensure the patient's comfort and avoid anal excoriation (Peate [193], E).
6. 10.Show
   Ask the patient to retain the suppository for 20 minutes or until they are no longer able to do so. If a medicated suppository is given, remind the patient that its aim is not to stimulate evacuation and that the patient should retain the suppository for at least 20 minutes or as long as possible. Inform the patient that there may be some discharge as the medication melts in the rectum.
   This will allow the suppository to melt and release the active ingredients (Peate [193], E).

Post‐procedure

1. 11.Show
   Remove and dispose of equipment, gloves and apron. Wash hands with soap and water or use an alcohol‐based handrub.
   For infection prevention and control (NHS England and NHSI [161], C).
2. 12.Show
   Record that the suppository has been given, the effect on the patient and the result (amount, colour, consistency and content, using the Bristol Stool Chart; see Figure 6.3), if appropriate, in the relevant documents.
   To monitor the patient's bowel function (Peate [193], C) and to maintain accurate records (NMC [178], C).
3. 13.Show
   Observe the patient for any adverse reactions.
   To monitor for any complications (Peate [193], E).