Dear Sheila,
I manage a residential home for the elderly and one of my residents has been prescribed a short course suppositories. Several staff feel that they should not give these as ‘it is invasive’ and they have never done them before. I have suggested that they follow the PIL, gain consent and if possible have a chaperone (particularly if male), I have also suggested seeing if the resident can manage this themselves. Failing this, I feel there is little that can go wrong as long as they follow the correct instructions. My argument being that who else is going to administer them if the person cannot manage them? After all, we administer all other medication.

Answered by Sheila Scott

Dear Candyce,

Thank you for your question.

Questions like this are never straightforward.

I asked a colleague, Philippa Shirtcliffe for her opinion and this is what she said:

If the staff are care workers, this would usually be considered medication by specialised technique (QCS Medication policy) and should only be undertaken when training and competency assessment by a registered nurse has taken place. It is not classed as a routine activity for care workers. It is, however, a delegated nursing task, so if a nurse has delegated she must feel confident that the person she has delegated it to has the skills and knowledge to complete the activity.

Rule of thumb is if the staff still don’t feel comfortable doing the task, they shouldn’t do it. Staff should also work within the Mental Capacity Act and ensure consent is obtained otherwise the administration of suppositories could be considered an assault and would be a safeguarding matter.  

This is very similar to my advice below:

There should be a policy in place in the home for the delivery of “medication by specialised technique” .

I would expect that the policy might include a statement that in the event of suppositories being prescribed the GP should arrange for the suppositories to be given under the supervision of the Community Nursing Service (a Registered Nurse).

The community nurses would then train the carers to give the suppositories and once the Community Nursing Service has decided that the care staff are competent to give them, there should be a document signed by the community nurse to state that each individual carer is competent.

You would need to be sure that you have the right equipment for the carers to give the suppositories (gloves and lubricant).

Assuming that the service user is not able to give the suppository to themselves as people living at home normally do then the task, once the appropriate training has been given, is quite straightforward.

I think your carers are right to be cautious but with an appropriate policy in place and the support of the community nursing service, I think that the carers should feel that they are being well supported. As my colleague said above if they are still not happy then they should not be expected to carry out the task.

Best wishes.

Sheila