Application and use of E-stim within HHA scope?

[kparry]

Is the use of E-stim within the scope of practice of a Home Health Aide or a CNA working in Home Health? The SCI patient is tetraplegic and unable to apply nor start/stop the units without maximum assist.

Although we would like to help, we feel BioNess Handmaster use is best left to family members or PT / OT.

Alternatively, we feel documentation and sign-off on HHA training by OTR might be sufficient. Nevertheless, not if E-stim is outside the scope of practice of a Home Health Aide.

[anothergrumpyoldRN]

It is not within scope of HHA employed by CMS Home Health in my state.

We can, however, train whomever the patient would like to designate to be that provider as long as it is not our staff for whom we are responsible.

[WoundedBird]

From my past career in sports medicine where e-stim was a commonly used modality and my current nursing education, I would say that it is outside the scope of practice for an aide and do agree with you that PT/OT would be a better provider. I personally think there are too many elements of correctly administering e-stim (electrode placement, intensity, pattern of stimulation...) that need the knowledge of PT/OT to ensure that the treatment is working towards the intended goal. I would hate to see settings for muscle contractions (I'm assuming that's a goal for your SCI patient) get changed to ones designed for pain relief because someone thought 'switching it up' would be beneficial to the patient when it might not and they wouldn't know the why behind the science.

Hopefully this has helped a bit and I haven't gone too far into the dryness that can be e-stim parameters. If you would like more info on that stuff, let me know and I can gladly share my knowledge on the specifics of hi-volt, interferential, Russian, etc. (see, there goes my inner modalities geek...time to put her away before she rambles on about iontophoresis or ultrasound.)