Cold, Dry Applications (Cold Packs) 

Goal: 

To prevent edema, help control bleeding, relieve pain, or reduce muscle spasms. 

Equipment: 

• Instant ice compress 

• Towel 

Procedure: 

1. Preparation: 

• Cold, dry applications are applied by a licensed nurse with a specific order from the physician. 

• Cold, dry applications may be applied as an emergency treatment without a physician's order, but the application must be confirmed with the physician as soon as possible. 

2. Activation: 

• Lay the instant ice compress pouch on a solid surface. 

• Strike the bag to release the activator fluid. 

• Shake the contents to mix the chemicals. 

3. Application: 

• Wrap the ice compress in a towel. 

• Apply the cold pack to the area of treatment for the duration indicated in the physician’s orders. 

• Monitor the skin intermittently for signs and symptoms of tissue damage. 

Monitoring: 

• Check the skin every few minutes for any signs of adverse reactions, such as redness, blistering, or excessive paleness. 

• Discontinue use immediately if any signs of tissue damage are observed and notify the physician. 

Compliance and Documentation: 

• Adhere to CMS guidelines and Requirements of Participation for Long-Term Care Facilities. 

• Document the use of cold, dry applications, including the resident’s response and any observations of skin condition, in their medical record. 

• Note the duration and frequency of application as per the physician’s order. 

• Regularly review and update techniques for applying cold packs according to the latest clinical best practices and regulatory standards. 

• Provide training to staff on proper procedures for cold, dry applications to ensure resident safety and effective treatment. 

• Conduct regular audits to ensure compliance with this policy and address any gaps in practice or documentation. 

References: 

• Centers for Medicare & Medicaid Services (CMS). State Operations Manual (SOM), Appendix PP - Guidance to Surveyors for Long-Term Care Facilities. 

• CMS Requirements of Participation for Nursing Homes.