Enemas - Prepared 

Purpose: 

To cleanse the lower bowel for relief of constipation, promote bowel elimination, and/or in preparation for a diagnostic procedure. 

Policy: 

Enemas are given per physician’s order by a licensed nurse. The order will identify the specific type of enema, route, and frequency of administration. 

Procedure: 

1. Preparation: 

• Bring the enema and related equipment to the resident’s bedside. 

• Ensure the enema solution is warm. 

2. Positioning: 

• Position the resident on their side, typically the left side for ease of administration and optimal results. 

3. Administration: 

• Remove the protective shield from the tip of the enema container. 

• Insert the lubricated enema tip into the resident’s rectum carefully. 

• Using steady pressure, squeeze the bottle until nearly all the liquid is expelled into the rectum or the resident complains of discomfort. 

4. Post-Administration: 

• Encourage the resident to maintain the position until the urge to defecate is strong (usually 2-5 minutes). 

• If indicated, assist the resident to the toilet, bedpan, or commode. 

• Note the results of the enema. 

5. Documentation: 

• Document the procedure and results in the Medication Administration Record (MAR) and in the nurse’s notes if indicated. 

Compliance and Documentation: 

• Adhere to CMS guidelines and Requirements of Participation for Long-Term Care Facilities. 

• Document the enema administration procedure, including the resident’s response and any observations, in their medical record. 

• Note any abnormalities or difficulties encountered during the procedure. 

• Regularly review and update techniques for enema administration according to the latest clinical best practices and regulatory standards. 

• Provide training to staff on proper enema administration procedures to ensure resident safety and comfort. 

• Conduct regular audits to ensure compliance with this policy and address any gaps in practice or documentation. 

References: 

• Centers for Medicare & Medicaid Services (CMS). State Operations Manual (SOM), Appendix PP - Guidance to Surveyors for Long-Term Care Facilities. 

• CMS Requirements of Participation for Nursing Homes.