calmoseptine

[makes needs known]

In your LTC facility, are cna's legally allowed to apply barrier creams? We use calmoseptine and have just been informed that because of ingredients in it, it needs to be applied by the nurse. I was a cna for many years and I applied barrier creams. It make sense for cna to apply after performing peri-care. I checked ingredients are: zinc and menthol. We have been told because they were written in our tx book that the nurse is suppose to apply. We were told that NY nurses were in trouble/suspended/lost license? for allowing aides to apply creams with peri-care when they bathe patients. What case is our facility referring to? Do you use calmoseptine?

[vald96]

yes,in my facility we used it and we include it as our skin care guidelines and we got medical director to approved it for c.n.a. to apply it,now its different if you write on tar looks like its physicians order for that residents and should be administered by a license nurse so its really how you write it.....

[bjaeram]

In my LTC facility if its on the MAR/TAR then the nurse has to apply it. Its a "doctors order" and there for must be done by the nurse. The powers that be in the facility rationalize it to this..its no different than a doctor ordering tylenol..the CNA can't give the med (even though its an OTC med) the nurse has to, so even with skin barriers, creams, lotions etc..the doc ordered it..the nurse has to to it.

a bit silly, because we can use "nursing judgement" and decide to use a barrier on a patients red bottom and give the CNA a little bit of the barrier cream to apply..but once it becomes a doc order, its on the nurse to apply it.

Doctors orders also include diet, amblation, Ted's, vitals, ect....all kinds of things not performed by only the nurse. An order does not have to be carried out by the nurse at all. They write orders for PT, Radiology, Lab, ect.....That argument holds no water.

I see absolutely no reason a CNA can't do this. I don't know the law but common sense says it's fine.

[scorpio72]

I agree with michelle126, i really don't have the time to apply barrier creams and such throughout the day. The LNA's at the LTC facility know who needs what to treat any skin issues and they ask the nurses if they need any of it. If there is a change in skin condition,of course I will asses and obtain further orders if necessary.I do apply skin prep myself though,so I can asses those areas to prevent skin breakdown. The LNA's at my facility are the best,and work very hard. To all the CNA's/LNA's out there...You ALL are the backbone of LTC and we couldn't do our jobs without you.THANK YOU!!!!

[ktwlpn, LPN]

Every facility's policy is different.We have a lot of pool and float cna's and we leave a note at the bedside to "call nurse for treatment" and we then carry the ointments with us during med pass-only takes a minute to hand a dab to the cna....Someone is always getting smacked around for leaving that stuff at the bedside.You might not think that's a big deal until a resident applies it to her morning toast-she thought it was strawberry cream cheese....

[leslie :-D]

i definitely understand it being in the tar.

in ltc, a good amt of the residents are incontinent and/or non-ambulatory.

maintaining skin integrity, shiould be on the nurse.

however, i don't think the order means the nurse has to apply it him/herself.

we can delegate this, and should.

but we also need to remind the cna's, to get us for even a reddened bottom.

iow, it's our judgment as to what looks ominous, and no one else's.

leslie

[CT Pixie, BSN, RN]

Doctors orders also include diet, amblation, Ted's, vitals, ect....all kinds of things not performed by only the nurse. An order does not have to be carried out by the nurse at all. They write orders for PT, Radiology, Lab, ect.....That argument holds no water.

I see absolutely no reason a CNA can't do this. I don't know the law but common sense says it's fine.

I didn't say it..nor did I say I agree with it

[gentlegiver, ASN, LPN, RN]

My CNA's always apply creams, unless it's a prescription cream for an infection or other severe skin problem. Then I leave it up to them as to whether they feel comfortable applying it, some do, some don't. But, I also ask them (the CNA) to call me so I can see thier (the patients) bottoms at least once a shift. This way i can gauge whether the treatment is working or not. I've been very lucky, I work with some really Great CNA's!!! They are my eyes & arms on the unit, I couldn't do my job with out them!

[makes needs known]

Hi thanks for all your responses. Our management has told us we could lose our jobs/ license, if we allow aides to apply calmoseptine and then sign off on it in the TARS without doing it ourselves. They site a real case in NYS where this happened. AND they have told the cna's that they are not suppose to apply these creams, so who do you think will apply these creams if the nurse does not. When I was cna, I always knew that people who are incontinent of urine and feces needed a barrier cream. Some of the cna's will still come to me for the barrier cream to apply, and I want to protect skin. Some rules were meant to be broken. Thanks again everyone:)

[Simba&NalasMom, LPN]

Hi thanks for all your responses. Our management has told us we could lose our jobs/ license, if we allow aides to apply calmoseptine and then sign off on it in the TARS without doing it ourselves. They site a real case in NYS where this happened. AND they have told the cna's that they are not suppose to apply these creams, so who do you think will apply these creams if the nurse does not. When I was cna, I always knew that people who are incontinent of urine and feces needed a barrier cream. Some of the cna's will still come to me for the barrier cream to apply, and I want to protect skin. Some rules were meant to be broken. Thanks again everyone:)

Maybe NY is an overly anal state, but the way around it here in OR is have the order on the TAR read something like "Caregiver to apply such and such cream q shift." The nurse signs the TAR, and the outcome is gauged by the weekly skin assessments which are also in the TAR.

[Forever Sunshine, ASN, RN]

Hi thanks for all your responses. Our management has told us we could lose our jobs/ license, if we allow aides to apply calmoseptine and then sign off on it in the TARS without doing it ourselves. They site a real case in NYS where this happened. AND they have told the cna's that they are not suppose to apply these creams, so who do you think will apply these creams if the nurse does not. When I was cna, I always knew that people who are incontinent of urine and feces needed a barrier cream. Some of the cna's will still come to me for the barrier cream to apply, and I want to protect skin. Some rules were meant to be broken. Thanks again everyone:)

Since CNAs are the ones 99.9% of the time changing a resident and doing their personal care, it should be put on during that time. It just doesn't make sense for it to be applied whenever we get around to doing treatments.

[makes needs known]

We have a meeting this week about the calmoseptine, etc. Our new management has been implementing alot of changes that are very upsetting and making it hard to get it all done. Thanks again.