When is Dr. order required?

[ttouslee]

I am needing to verify when a dr. order is required in home health and when its not. We have a client that requested our aide put ace wraps on her LE. the aide placed them and notified the primary nurse that she did this. We have had discussions at length whether this requires a dr. order or not. Can someone point me in the right direction of finding this type of info

Thanks in advance for any help

Tammy

[JustBeachyNurse, LPN]

In my agency, yes a physician order is needed for compression stockings or wraps. As an assessment needs to be done and an appropriate diagnosis needs to be in the plan of care as well as appropriate goals. I recall one patient who wanted ACE wraps because their friend used them & suggested they may work for her. However in this case the LE edema was new onset and required formal assessment. Fortunately the CHHA called the nurse first to report the change in condition & patient request first.

Also the aide needs to demonstrate competence (if permitted to apply compression dressings other than TEDs/stockings as there is much room for error. Most companies in my area limit applying compression dressings that are not TEDs/stockings (ACE wraps, unna boots, etcetera) to nurses and certain PTs. It seems that only in a facility where there is a nurse that can check the ace application can the task be delegated to a CNA or CHHA. ).