Wound Vac Scope of Practice

[Passion8RN]

I have a patient that has private paid home health aides. He has multiple wounds and we have trained them to provide the wound care. They were doing a great job, but now his podiatrist applied a wound vac to the most complex wound. My concern is, they instructed the home health aide on the wound vac and expected her to change it 3 x weekly. The home health aide is through a private duty agency, but called me and said she was not comfortable doing this type of dressing change, but we did not have orders to perform wound vac drsg change. So the question is, Is this even within their scope? I've never even heard of people doing their own wound vac dressings changes at home, let alone a paid unlicensed caregiver. In my experience, this type of drsg change has been done by skilled personnel. This idea is new for me. Is it ok to teach the home health aide this skill?

[Passion8RN]

I did find this link that somewhat clarified my question http://www.kci1.com/cs/Satellite?blobcol=urldata&blobheadername1=Content-type&blobheadername2=Content-disposition&blobheadername3=MDT-Type&blobheadervalue1=application%2Fpdf&blobheadervalue2=inline%3B+filename%3D396%252F678%252FV.A.C.%2BTherapy%2B101%2BAwareness%2BBrochure.pdf.pdf&blobheadervalue3=abinary%3B+chorificet%3DUTF-8&blobkey=id&blobtable=MungoBlobs&blobwhere=1226639760702&ssbinary=true

[JustBeachyNurse, LPN]

Usually no as assessment skills are required when checking the wound, it cannot be delegated to a CHHA. While a family member can be taught, it's really only a nurse (RN/LPN level skill)

Even the document you linked states home care nurse ( or qualified FAMILY member) not CHHA/HHA. This is skilled care not ADLs

[Passion8RN]

My thoughts exactly. I didn't quite understand how a chha can do this when changing the drsg calls for an "assessment" and there is more risk involved with wound vac therapy. Also, I didn't mention that the clinic placed black foam directly over an exposed tendon. I called KCI and the clarified this should never happen and that there needs to be a nonadherent mesh barrier drsg in between this. This makes me question the competency of the podiatry clinic that applied it.

[sharpeimom]

When my husband had a wound vac following surgery two years ago and a wound specialist nurse came to the house daily, then twice a week, and she did not want anyone else to change his dressing OR change the vac. She showed me what to watch for but said that my job was to be his wife. That was fine with me!

Wound assessment is not for aides.

[kiszi, RN]

No, no. Where I worked the nurses did not teach vac application to family or caregivers per policy. Seems there is too much potential for things to go wrong. Heck, there are nurses trained and inserviced on vacs that still screw them up!

[kiszi, RN]

That said, generally skilled care can indeed be taught to family members, such as wound packing or IV administration. I think the wound vac exception falls more into the common sense category.

[Passion8RN]

Thank you all for your responses. We will be discharging this patient and referring to another hha because this case has too much liability risk and poor caregiver/ family adherence to POC.

[caliotter3]

Thank you all for your responses. We will be discharging this patient and referring to another hha because this case has too much liability risk and poor caregiver/ family adherence to POC.

If only more cases were discharged due to too much liability risk and poor CG/family adherence to POC, like the one where I now work!