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A suppository is a small, bullet-shaped pellet used as a method of drug administration. Most commonly, suppositories are used to help bowel emptying due to constipation when other treatments have failed, but they are also an effective method for pain relief and when the oral route is not tolerated.1
This guide provides a step-by-step approach to administering a suppository in an OSCE setting.
Contraindications
The use of suppositories is contraindicated when one or more of the following are present:
- Chronic constipation, which would require repetitive use
- Paralytic ileus
- Colonic obstruction
- Malignancy of the perianal region
- Low platelet count
- Following gastrointestinal or gynaecological surgery, unless on the specific instructions of the surgeon1
Gather equipment
Collect the equipment required for the procedure and place it within reach on a tray or trolley, ensuring that all the items are clearly visible:
- Non-sterile gloves
- Disposable apron
- Suppository, as prescribed
- Lubricating gel
- Disposable incontinence sheet
- Gauze or tissue
- Bedpan or commode (if required)
Introduction
Wash your hands using alcohol gel. If your hands are visibly soiled, wash them with soap and water.
Don PPE if appropriate.
Introduce yourself to the patient including your name and role.
Confirm the patient’s name and date of birth.
Briefly explain what the procedure will involve using patient-friendly language: “I have been asked to give you a medication that is best given as a suppository. This is a small capsule that is inserted into your rectum (back passage). You may experience some discomfort during the procedure; however, it will only last a short time.”
Explain the need for a chaperone: “One of the other staff members will be present throughout the procedure, acting as a chaperone, would that be ok?”
Check the patient’s understanding of the medication being administered and explain the indication for the treatment.
Gain consent to proceed.
Check if the patient has any allergies.
Ask the patient if they have any pain before continuing with the clinical procedure.
Explain to the patient that they’ll need to remove their underwear and lie on their left side with their knees bent up (flexed) with their left buttock on the edge of the bed. Provide the patient with privacy to undress and a sheet to remain covered until the procedure begins, or assist if needed. Check it is ok to re-enter the room before doing so.
Ensure a bedpan, commode, or toilet is easily accessible in case of a sudden bowel movement.
Final checks
Before proceeding, check the seven rights of medication administration.
1. Right person: ask the patient to confirm their details and then compare this to the patient’s wristband (if present) and the prescription. You should use at least two identifiers.
2. Right drug: check the labelled drug against the prescription and ensure the medication hasn’t expired
3. Right dose: check the drug dose against the prescription to ensure it is correct
4. Right time: confirm the appropriate time to administer the medication and check when the patient received a previous dose if relevant
5. Right route: check that the planned route is appropriate for the medication you are administering
6. Right to refuse: ensure that valid consent has been gained before medication administration
7. Right documentation of the prescription and allergies: ensure that the prescription is valid and check the patient isn’t allergic to the medication you will administer
Administering a suppository
1. Wash your hands again.
2. Don non-sterile gloves and a disposable apron.
3. Place an incontinence sheet underneath the patient’s hips and buttocks.
4. Apply lubricating gel to the end of the suppository.
5. Separate the patient’s buttocks and inspect the perianal area, including for evidence of skin soreness, excoriations, haemorrhoids or prolapse.
6. Insert the suppository using the correct end, using a finger to advance 2-4 cm to prevent it from being ejected.
- A suppository typically has an insertion end, which will be described in the manufacturer’s instructions
- Repeat if additional suppositories are required
7. Clean the perianal area with gauze or tissue.
8. Remove the incontinence sheet and replace the sheet to maintain patient dignity.
Administration via a stoma
Suppositories can be administered via a stoma, however, local policy should always be followed due to medication licensing matters.
To complete the procedure…
Explain to the patient that the procedure is now complete.
Ask the patient to avoid opening their bowels for at least 20 minutes or until they are no longer able to do so. Inform them that they may experience some rectal discharge as the suppository melts.
Thank the patient for their time.
Dispose of your PPE and other clinical waste into an appropriate clinical waste bin.
Wash your hands.
Document the details of the procedure and the medication administered, including the date, time and your signature.
Editor
Dr Jamie Scriven
References
- Dougherty L, Lister S. The Royal Marsden Manual of Clinical Nursing Procedures, Professional Edition. 9th ed. Wiley-Blackwell. 2015.
- Potter PA, Perry AG, Stocker PA et al. Chapter 31: Medication administration. In: Fundamentals of Nursing. 10th ed. Elsevier. 2021.
- Mitchell A. Administering a suppository: types, considerations and procedure. British Journal of Nursing. 2019. Available from: [LINK].
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