CNA's Applying heat

[CRNA2BKY]

I have a question. I am now working in a home health care setting, and we have a pt that needs a heating pad applied to his shoulder. My question: can a CNA legally (in the state of FL, or anywhere) apply the heat without any supervision for a nurse? The CNA's do the daily care, so I was wondering if it were legal for the CNA to apply the electric heating pad periodically without a nurse supervising.

[Neuro Guy NP, DNP, PhD, APRN]

Well, I can't say as to whether it is legal or not in FL, but I don't see a problem, provided that the pt does not have pathophys causing decreased sensation such as diabetes, PAD or something like that. The unlicensed provider may not realize that pts with such conditions should not use heat because they may inadvertently burn themselves. I would just say think about the person's disease process before allowing it.

[Flo., BSN, RN]

Isn't it kinda the same as a CNA applying ice?

[Kyrshamarks, BSN, RN]

Come on think about your question for a second. Can a CNA apply heat? You are talking about an over the counter heating pad that the patient buys and can have a 3 year old child apply to them. It is not rocket science and it is not illegal. As an RN with 25 years experience, I wish that more nurses used common sense and also stop acting as if CNA's are not capable of reasonable thought. As nurses, we tend to read to much into something too simple.

[evolvingrn, BSN, RN]

I don't like them to apply heat without asking me first if its the first time using it for pain control ect.........but they do it anyway. (not homecare)

[ky_grl82]

I honestly had an intructor tell me (RN nursing student) we could not apply heating pads or ice with out a doctors orders... I nearly laughed so hard I peed! I doubt that is true (I had other instructors contraindicate this) and even if it is, I will never make a call to get a flipping order for a heating pad. Sorry, that is just dumb. However, a CNA might need to ask the nurse first. I am sure there are times when a heating pad would be contraindicated that a CNA might not be aware of.

[psu_213, BSN, RN]

Come on think about your question for a second. Can a CNA apply heat? You are talking about an over the counter heating pad that the patient buys and can have a 3 year old child apply to them. It is not rocket science and it is not illegal. As an RN with 25 years experience, I wish that more nurses used common sense and also stop acting as if CNA's are not capable of reasonable thought. As nurses, we tend to read to much into something too simple.

And I once knew of an RN using a blow dryer to dry under a LTC resident's cast (because the CNA allowed water to get under it during the resident's bath). Anyway, this RN used the blow dryer agreesively enough that the resident developed a burn with blisters under cast.

When I was an aide I was told that cold is OK for the RN/aide to apply, but a doctor's order is required for heat. (is that true?)

[tokmom, BSN, RN]

Where I work now, the CNA can apply heat and ice, but they always ask us if it is ok. Afterall, I want to know why it is being applied, the site needs to be monitored and there are reasons that pt's should not have either applied.

In another hospital I worked at, even the k pad had to be ordered by the MD. Ice was ok.

[jmqphd]

My understanding is that heating pads are a big no-no for the elderly. Nightmare cases of burns. This is probably most true with lower extremities. But patients nodding off while the pad is on...

I wouldn't do it. But, I've never been in home health.

My advice is that if the pad is OTC, I'd tell the patient the possible adverse effects and let them make their own decisions.

[SkiMama]

In our company no one can apply heat (hot packs) except therapists. Not even nursing. Just had another inservice about it due to some improperly applying heat to pts.

So not a dumb question at all.

[MurrR]

Depends. Where I work we have no such thing as OTC treatments or meds, everything must be by doctor's order or be covered by a protocol that's been reviewed by my supervisor. It's a company policy - regardless of the legality, I'd probably lose my job for doing it without an order/protocol.

Legally, in Oregon at least, a CNA can apply heat and cool - as long as they're not a total moron about it and leave their patient sitting on a heating pad for more than 20 minutes without checking/removing it. Ditto for cool. It has less to do with the OTC nature of the treatment and more to do with how smart/educated is the aid applying the treatment.

[prinsessa]

Where I work only PT/OT are supposed to apply heat. People still make their own heating packs to use. Heating packs can be dangerous especially if the person has diabetes or is elderly. I would be careful when using heating or ice packs.