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Sample Protocol

SAMPLE PROTOCOL

 

NAME OF FACILITY:

SUBJECT:  Aromatherapy

ORIGINATING DEPARTMENT: Nursing Administration

PURPOSE:  To identify the process of providing clinical aromatherapy safely to patients. 

(alternative) To provide a hospital based program that safely integrates the use of therapeutic essential oils into the routine care of the patient by experienced staff that facilitates the body’s innate healing response in a holistic environment during hospitalization and post-discharge.

RELATED REGULATIONS/LAWS:  State Board of Nursing Statement of Accountability for the Utilization of Integrative Therapies in Nursing Practices

RELATED STANDARDS:  (if applicable)

RELATED RESOURCES:  Buckle, Clinical Aromatherapy


DEFINITIONS:

Clinical Aromatherapy:  The controlled use of essential oils to address specific patient symptoms and enhance health and well-being.

Essential Oils: Essential oils are highly concentrated extracts from the aromatic parts of herbs, flowers, fruits, trees and grasses and are known for their therapeutic properties. 

Topical Application:  Providing the essential oil topically through the skin by massage/touch/compress/cotton squares with dilution of essential oils to cover affected area.

Inhalation Application:  Providing the essential oil using the olfactory system.

Direct Inhalation:  Applying drops of the essential oil to a cotton ball and instructing the patient to smell the essential oil as needed to relieve or decrease specific symptoms or increase well-being.

Indirect Inhalation:  Using a diffuser to diffuse essential oils into the patient room to relieve or decrease specific symptoms or increase well-being.

Carrier Oil:  Cold pressed vegetable oil or jojoba (liquid wax) into which the essential oils are mixed before the topical application of aromatherapy by such methods as massage or touch.

Patch Testing:  The process used to determine if a patient is sensitive to an essential oil before topical application is used.

POLICY:  

1. Essential Oils provided by (name of facility) will be administered by a licensed healthcare professional trained in the use of essential oils.
2. Equipment List (for essential oils on cotton balls or for massage)
    • Essential oils
    • Carrier oils
    • Cotton Balls
    • Small sealable plastic bags
    • Labels
    • Personal Protective Equipment (PPE)

    Or, Equipment List (for Inhalation Patches/Aromatherapy Inhalers)

    • Inhalation Patch or Aromatherapy Inhaler.
    3. Approved Locations for Application (only for topical application, not needed for Inhalation Patches/Aromatherapy Inhalers)
    •  Aromatherapy products used for patient care shall be used strictly in locations intended as single occupancy.
    • The use of aromatherapy products can be problematic to hypersensitive employees who are handling or have secondary exposure it the products. If an employee experiences symptoms, discontinue use and follow the protocols identified in the (list plan).

    4. Procedure for use

    Responsibility

    Action

    Assess patient for need and perception of problem, preferences of aroma, being touched, allergies, skin sensitivities, etc.

    Provide education about aromatherapy and explain procedure

    Obtain verbal consent

    Select essential oil or modality with patient input

    Identify method of application (applies for topical)

    Do a patch test (not needed for inhalation patches or aromatherapy inhalers)

    Provide treatment, disposing of any waste in the trash

    Evaluate patient response

    Document 

     

    5. Procedure for Accidents (not needed for inhalation patches or aromatherapy inhalers)

    Responsibility

    Action

    Essential oil in eye: Irrigate eye with milk or carrier oil and then with water

    Skin reaction/Irritation: Remove essential oil with milk or carrier oil. Wash with soap and water. Pat dry and leave open to air for 10 minutes.

    Essential oil bottle dropped or oil spilled: Use a paper towel to soak up spill and collect glass if bottle is broken. Wrap in more paper and dispose of in double sealed plastic bag.

    6. Documentation: Documentation includes provider, date/time, EO used, application method used, patient response

    7. References

     

    SAMPLE SDS

    SAMPLE COA