LeadingAge Washington
Member Survey, March 2010
Hot Packs
How do you handle hot pack orders from physicians, as well as residents who have those rice or flax seed bags that they heat in the microwave? Does staff assist with heating the rice bags? If so, how do they know how hot it is and how hot is too hot?
If you DO allow orders for hot packs, then what type is used and what is the protocol for placement?
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We order/keep on hand the hot packs that come as a plastic bag where you crush an internal bag of chemical that mixes with another chemical to create heat. The packs are always wrapped in a wash cloth or hand towel before placing on the skin. By using the manufactured hot packs, the heat intensity is not too hot and we don’t run the risk of a fire by heating items in a microwave. (NOTE: When I worked at a previous facility, we actually had a fire related to an aide heating a cloth item in a microwave at a resident’s request, resulting in fire/smoke/fire department response/smoke inhalation by 2 staff members.)
We also allow residents to use appropriate electric heating pads, reminding them not to have them directly against their skin. This is much safer than the rice or flax seed bags.
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We don’t have a protocol in place for the use of hot packs. This is something that has not come up for us. If we did receive an order it would be something that I would have the RN manage and administer for safety reasons.
I’m sure there are residents in the building with microwaves and rice bag heating pads that are doing selftreatment. If we became aware of a safety concern we would counsel the resident and family member and go from there. Electric heating pads are another concern as well. I know residents use them and that is their right but if we became concerned about safety we would discuss it with them and their POA.
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Steps for hot packs:
Usually M.D. ordered, as warm packs to affected site for 5-10 min. Staff will use moist washcloth, wrapped in
(plastic cooking) wrap, heat in microwave for at least 2 minutes, feel it (Checking the rt. temp.) then place on resident with a barrier between the skin and warm packs. Check in 3- 5 minutes. So far we have not any incidents….
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I would not allow anything that has to be heated in a microwave into a facility. Risk is too great for a burn. Any order for hot packs we did through rehab, i.e. therapists or rehab aide and we used moist heat. We had a hot pack machine that kept the hot packs wet and moist. They were put in covers and used. Even with this you have to be sure staff is trained so as not to put on a pack that will burn.
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We have had staff heat a resident’s own rice bag per that resident’s request and it was heated to be nice and warm to the touch.
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We do not allow caregivers to do hot packs even using the conventional rice bags or flax seed bags. If there's a physician order, our therapy department does it and/or LN only. If we have an order for nursing to do this, it's written as treatment, heat based on manufacturer's recommendation and the order must specify how long it should stay on the resident (standard is no greater than 20mins.)
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Hot pack and cold packs are “delegated” tasks for the safety of the resident. If needed the resident is placed in the nurse office with supervision from the nurse or an RA, NEVER in the resident rooms.
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