decubiti redux...

[NurseFirst]

A few months ago I had the opportunity to stir up a bit of controversy (quite unintentionally) about Chris Reeve and decubiti.

Now, I am asking for help. A dear friend of mine's Mom has been recently diagnosed with advanced terminal cancer (mets everywhere). I don't know whether hospice covers preventative treatment for decubiti, or if so, what kind.

I know when my Dad was in hospice, they paid for a hospital bed--but nothing special. I woke up every 2 hours to turn my Dad.

I'm interested in knowing what kinds of preventatives there are for decubiti...I guess beds are on the top of the list. But other things, too. I'd like to give my friend some recommendations--I don't think depending upon paid or unpaid caregivers to turn a patient every 2 hours is the best approach, especially if the caregiver is providing 24 hr care.

Suggestions? Comments?

Thanks...and happy 4th, everyone!!!

NurseFirst

[MacNurse]

Okay..as far as the skin prep...not sure if toughen the skin is the right words, but it does help prevent decubs. We use it over bony prominences..heels, elbows, ankles, spine, etc...it works and its easy.

Okay, thanks for the clarification...I was picturing you using some of the 'methods' for preventing pressure sore that my instructors talked about using in days gone by :chuckle :chuckle :chuckle

[CoffeeRTC, BSN, RN]

I'll bite....what are they?

[mebeafrn]

Here's my rationale for posting something from a critical care journal.

My posting was intended to bring literature and evidence to support the other posters, and what I found happened to be in a critical care journal.

Even if the person is palliative as nurses we still need to prevent pressure sores (let's face it they're usually painful, and probably the last thing that the patient would need).

The OP said that she was recently diagnosed, so I assumed that she has not being lying in bed for long periods of time, and isn't on death's door, just yet. All the more reason to prevent pressure sores. However, once someone is nearing the end, I would reassess turning them q2h, at that point it might just be too painful and futile.

wow,amazing how communication can break down,even when written. Let me try to clarify. The common theme I see IS support for basic skin care i.e. repositioning,pressure reduction,the skin prep or hydrocolloids are great,moisture barriers etc.. In keeping with Hospice philosophy the benefit of

AGGRESSIVE labs and nutritional intervention needs to be weighed against the s/s of the disease progression.

[MacNurse]

I'll bite....what are they?

Rubbing a 'special' brown soap over bony prominances, using rubbing alcohol to 'toughen' the skin before a sore developed. :chuckle :chuckle how our knowledge has changed eh?

[NurseFirst]

I guess I should clarify that I never intended to state that a mattress would replace turning/repositioning. I also stated the price because most places including our local Hosice and the Company that I work for have contracts with vendors so that we can reciece the mattresses at a reasonable price. Usually we just eat the cost of the mattress because it will not always be covered. Again comfort and safety should be a priorty.

I did do some clinical time in an LTC where the patient was on a bed, I assume with the type of mattress folks have described here, but which ALSO rotated the patient gently from side to side.

Anyone know much about these beds?

Thanks,

NurseFirst

[Bird2]

I did do some clinical time in an LTC where the patient was on a bed, I assume with the type of mattress folks have described here, but which ALSO rotated the patient gently from side to side.

Anyone know much about these beds?

Thanks,

NurseFirst

This sounds like a low air loss mattress. It can gently alternate pressure and it circulates air so that the skin to does not get sweaty. The alert residents that we have had on them say that they are very comfortable.

[MS._Jen_RN, ASN, RN]

One of the things that our facility uses for prevention of pressure sores is a ROHO mattress. Love 'em.

I have no other way to describe it other than a lot of little air filled cones covered with a canvas type cover. They make them for chairs and beds. They can be put on any chair or bed (twin sized or hospital bed). They can be covered by insurances including Hospice and require no power, unlike the low air loss variety. (We use both for different reasons.) The cover is water (and urine) resistant and the inside part is totally washable. If I remember right they are cheaper than the low air loss beds too. I'm sure that you could find some info on them online, if not email me and I'll try to get you some specifics.

~Jen

[laurenD]

Just a tidbit of trivia to remind us how important turning is in prevention of ulcers...

The average person respositions him/herself every 7 minutes while asleep.

I tried laying still, not even moving my arms/legs. I only made it 11 minutes before I decided I really really really wanted to adjust my position.

It certainly makes 2 hours seem like a long time!!