Trach Changes in Ohio

[rmcclurg1989]

Hello,

I've been scouring the ohio board of nursing website and the ORC and OAC all night hoping to find information about trach changes. My question is this, can LPNs in Ohio perform trach changes?

I have a pediatric patient on a ventilator. She woke up in the middle of the night and grabbed the circuit and started pulling. That made me think huh what if she pulls the entire cannula out? We have emergency supplies and trachs, the trach is also changed once a week. So again, long story short can LPNs change trachs in Ohio?

Thank you!

I

[Alex Egan, LPN, EMT-B]

Nurse practice acts are generally exclusionary. Meaning that the act will generally only state what you CANNOT do. In my brief review of Ohio law I couldn't find language that would exclude this procedure for LPNs. Refer to Lawriter - OAC - 4723-4-04 Standards relating to competent practice as a licensed practical nurse.

The fact that you are on a ventilator case and have not been trained in emergency procedures for decanulatuon is frankly alarming and in my opinion constitues a dangerous situation that should be immediately addressed by the RN, MD, or other practitioner you are operating under the direction of in compliance with 4723.01 (F).

Please feel free to PM of you want to discuss this issue further.

[rmcclurg1989]

I have been trained for such situations in case of an emergency, I stated we have emergency supplies and trachs. That was not my question, My question was related to whether or not I could do the weekly change within my scope of practice. There are other nurses that refuse to do it because they say it is out of their scope of practice. I was looking for facts not judgement to prove that it was within my scope.

[rmcclurg1989]

However, after reading my question I can see where that could be an assumption.

[Alex Egan, LPN, EMT-B]

The situation you described in your post did not seem to be referring to a routine change. I'm not sure how I was to infer that. The presence of emergency supplies does not imply the training or ability to utilize them.

No judgement from me, I assure you. Just concern for a situation I did not fully understand. Thank you for clarifying.

As I said and linked to it would seem that it is not specifically forbidden so this should be permitted. I am not a lawyer and do not practice in your state, so my opinion is just that. A quick call to you BON should clear things up.

I have found many LPNs hide beind scope of practice when they are not comfortable with a procedure. Also lots of LPNs confuse company policy with practice act. You company can restrict your practice in any way they choose, the state is a completely other matter. I have had many coworkers refuse to take verbal orders because a previous employer forbade it, and they mistakenly believed was not permitted by the state.

[Alex Egan, LPN, EMT-B]

The laws regarding scope of practice are so confusing. I wish my school had done a class on it. Really we got handed the practice act and told to review it after our NCLEX so we didn't get mixed up between what we could do in PA and what we could do in NCLEX land.

[rmcclurg1989]

I think I may go back and edit the question for future viewers, it was a spur of the moment question without proofreading. I have been noticing that my fellow employees use scope of practice to hide behind as well. I did find a class for ten dollars that teaches the NPA for my state. PA might have something similar.

My class was similar, we were handed a sheet of paper with FAQs and a link to the OBN website. I agree the scope of practice is confusing and the amount of information included within is a bit overwhelming.