The Prince Charles Hospital

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1 METRO NORTH HEALTH SERVICE DISTRICT THE PRINCE CHARLES HOSPITAL - PROCEDURE - TPCHS09006v1 TITLE DESCRIPTION TARGET AUDIENCE FACILITY/SERVICE Hot Packs Safe Application and Use Procedure to ensure that hot packs are applied in a method which is safe for the patient. All Staff The Prince Charles Hospital Procedure Objective: To ensure patient safety by:- Outlining precautions and contraindications to the application of hot packs Describe the process of assessment for suitability for hot packs Detail the methods to be used in application of hot packs to patients To ensure patient safety, hot packs are only to be applied by a Physiotherapist, Occupational Therapist, Registered Nurse, or Medical Officer following:- An assessment of the patients suitability for application of heat The hot/cold skin test has been performed. Heat therapy may be Nurse initiated for general patient comfort and relaxation or a therapeutic treatment prescribed by a Physiotherapist or Medical Officer. Background: Application of hot packs may assist in temporary pain relief and reduction of muscle spasm, increasing localised blood circulation and increased connective tissue extensibility. Application of heat in the hospital setting may be by hydrocollator hot pack or disposable chemical hot pack. Conduction of heat and heating of body tissue is dependant upon many factors including latent temperature, core body temperature, skin thickness, thickness of fat and muscle, water content of tissue, and blood flow through tissue. The health professional applying and or monitoring an application of heat should take care to observe the patient and their physiological responses to avoid tissue damage and possible tissue burns. The application of electronic heat pads, hot water bottles and microwaveable wheat and gel heat packs has been deemed unsafe and these items have been removed from circulation. Caution: Failure to correctly assess a patient for heat or correctly apply the hot pack will leave the patient at risk of a thermal burn. Definition of Terms: Hot pack: Hydrocollator: Disposable chemical pack: A canvas envelope containing a silica gel which is immersed in the heated water of a hydrocollator unit. An automatic heating unit which holds a supply of hot packs heated in water at a constant temperature of C ready for use. Commercially available (via Supply), single use chemical hot pack TPCHS09006v1 Printed version is an uncontrolled copy Page 1 of 5

2 Purpose: Pain reduction Reduce muscle spasm Increase localised blood circulation Increase connective tissue extensibility Indications: Musculoskeletal pain Arthritic pain Muscle spasm Adhesions Oedema Vasodilation for IV therapy access Phlebitis Precautions for use of hot packs: The effects of heat to a body area do not remain localised. Vasodilation from heat spreads to adjacent areas. Heat applied to one limb may affect the other limbs. Therefore the exclusion criteria must be considered for the whole patient and not just the treatment area. Also of note is that heat applied to the abdomen has irregular effects on blood supply. This may result in a decrease in blood flow to the bowel with heat applied to the abdominal wall. Care should be taken with those patients currently receiving analgesia medications which can reduce sensory capacity to heat. The patient must remain awake and alert during the therapy. Contraindications for use of hot packs: Not consented Failed hot/cold skin discrimination test impaired sensation in treatment area Unreliable patient i.e. poor communication or history of non-compliance Acute inflammation eg. bruising within the last 48hours Circulatory dysfunction eg Peripheral Vascular Disease Infection and open wound Cancer or Tuberculosis Gross Oedema Regions treated with radiation therapy within three months prior to treatment Liniments applied recently to the treatment area - may cause hypersensitivity to heat Patients who are sleeping, unconscious or anaesthetised eg. epidural in-situ Skin disorders such as eczema or dermatitis Haemorrhagic conditions Procedure: Skin test: Check the patient for contraindications/exclusion criteria. Question the patient as to whether there is any numbness or change in sensation in the area to be treated. Test the skin sensation/discrimination over the area to be treated - using two containers (eg screw top jars such as specimen jars) filled with warm and cold water. Place these containers on the area to be treated and look for inability to reliably discriminate hot from cold. If the patient is not able to reliably discriminate between the two, they have failed the skin test and heat must not be used. Or Test the skin sensitivity over area to be treated Place the hot pack on the area for 60 seconds. TPCHS09006v1 Printed version is an uncontrolled copy Page 2 of 5

3 The patient fails if they cannot detect a hot sensation. Check for excessive redness or blanching before and after application. If this occurs the patient fails the skin test and heat must not be used. Warning: The following warning must be given before applying heat: When having a heat treatment all you should feel is mild, comfortable warmth. If you feel any more than this or if the heat concentrates in any particular spot or it starts to feel uncomfortable you must press the call bell/buzzer immediately. If you fail to call for help immediately you may be in danger of being burnt. If in doubt please call [the staff member applying the hot pack]. Please do not move or touch any of the equipment during treatment. If you become uncomfortable call [the staff member applying the hot pack]. Do you understand what I have said? Do you have any questions? Are you happy for me to proceed? Application: Wrap the hot pack in an appropriate cover or adequate towelling layers to protect patient (Minimum of 2cm of towelling between the patient and the hot pack). Apply the hot pack do not allow the patient to lie on the hot pack as this may cause localised overheating. Supply the patient with a bell/buzzer to call for help. Check the skin after 3-5 minutes for any abnormal reaction (normal reaction is a pink or reddened flush) Check regularly every 10 minutes thereafter to evaluate the efficacy of the hot pack. Heat should be applied for no more than 30min, followed by a treatment free period of 1 hour. A skin test does not need to be repeated for subsequent applications unless something in the patient s condition changes. Return hydrocollator pack to heating unit to avoid drying out. Disposable Chemical hot pack Activate as per manufacturers instructions on back of pack. Place inside folded towel before striking with open hand to activate to minimise risk of bursting packaging and leakage of fluid. Note: At no time should hot packs be heated in a microwave oven. Heat-wheat packs are not approved for the hospital setting due to a tendency to spontaneously combust. Gel packs are unsuitable to heat for use as a hot pack as there is no way to determine the temperature of the pack. Hot water bottles are unsuitable for use. Electrical heat pads are no longer deemed safe for patient use. Document the following in the medical record:- The results of the skin testing That the warning was given and understood Consent for the treatment was gained Position of application and duration Any resulting adverse skin reaction are to be documented and logged as an incident on AIMS Subsequent applications are to be documented by either the nurse or therapist in the medical record. Skin test need not be repeated unless a change in skin integrity or sensation is reported. TPCHS09006v1 Printed version is an uncontrolled copy Page 3 of 5

4 MARKETING/COMMUNICATION Marketing/Communication Responsibility Assistant Dir. of Physiotherapy (ADOP) Orthopaedics/OPD/ED - Local NM Policy & Procedure - District Marketing/Communication Strategy Physiotherapy Work Unit Guidelines folder. Notification NO4- NO7, Director Physiotherapy for dissemination to all staff Notice in District Newsletter Publish on QHEPS AUDIT STRATEGY Level of Risk Medium Audit Strategy Review clinical incidents for patient injury Audit Tool Attached No Audit Date 12 monthly with annual review Audit Responsibility ADOP- Orthopaedics/OPD/ED Key Elements/Indicators/Outcomes Review Clinical Incident via AIMS report Audit charts for appropriate documentation REVIEW STRATEGY Minor Review Date 1 30 Sep 2010 Minor Review Date 2 30 Sep 2011 Major Review Date 30 Sep 2012 Review Responsibility Director of Physiotherapy Services (DOP) & ADOP- Orthopaedics/OPD/ED PUBLISHING INFORMATION Version V2 Version Date 27 Jul 2009 Effective Date 15 Sep 2009 Author/s, Position & Business Area Key Stakeholders who reviewed this version, Position & Business Area Replacement For Information Source Maureen Brown, Physiotherapist and Aaron Lamont, ADOP Orthopaedics/OPD/ED Physiotherapy Staff Nicole Bellet Director of Physiotherapy Services (DOP) Helen Smart NM Policy & Procedure NHSD Mark Butterworth Exec. Dir. Allied Health PRONHSD080091v1 Hot pack - Safe Application and Use References: VJ Robertson, LS Chipchase, EL Laakso, KM Whelan and LJ Mckenna, Australian Physiotherapy Association: Guidelines for the Clinical Use of Electrophysical Agents, (2001) Low J and Reed A. Electrotherapy Explained. 3rd Ed, Oxford: Butterworth-Heinemann Ltd. (2000) Wadsworth and Chanmugam. Electrophysical Agents in Physiotherapy. 2nd Ed, Science Press, Merrickville. (1988) Workplace Health & Safety Act 1995 SEARCH INFORMATION Key Words Physiotherapy, Heat, Patient, Treatment, Hot packs EQuIP and other Standards 1.3.1, TPCHS09006v1 Printed version is an uncontrolled copy Page 4 of 5

5 Endorsed Ms. Debra Cutler Executive Director Nursing & Midwifery Services Dr. Stephen Ayre Executive Director Medical Services Approval Mr. Mark Butterworth Executive Director of Allied Health TPCHS09006v1 Printed version is an uncontrolled copy Page 5 of 5

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