White and grey wound

[emilysmom,RN]

Patient with white and grey wound. Saw a PCP they told him to go to Urgent care at the VA for wound care orders, supplies. He did not go. I have asked him to go to a WCC he still has not gone. I have been putting on telfa tape that is what his PCP sent with him. Also is a non compliant diabetic. Had a possible seizure was told not to drive at least until he sees his neuro MD, which is this week. But he refuses to stop driving, I have set up our local paratransit but he refuses to use it. What else to do? Of course I have discussed with my clinical manager and his PCP and documented everything along the way. How else to help non compliant pts.

[ruthalittle]

Can you get orders for NP (WCC or WCON) to eval & Tx wound in his home? The one I often use bills under Medicare part B so there's no conflict with home care. They can usually perform sharp debridement if indicated. I once had an UNBELIEVABLY non compliant patient with mixed venous- arterial wounds, Medi honey/ foam/ rolled gauze/ tubi grip ordered. She just kept taking the dressings off ( "The air needs to get to it!") & they just kept getting worse & worse. She refused to let her family take her to the wound care center, or anywhere at all.

We asked the PCP for orders for NP to eval & Tx, & that helped quite a bit.

Now that Accuzyme is no longer available, I think Medi honey & foam is the next best thing (besides sharp debridement).

Wish I knew how to make the little "huggies" here. (RE your "I'm done" comment). Are you full time salaried? Maybe your company will allow you to go to per Diem? Then you can give some of your patients to other nurses? As an RN in home care you'll still have to deal with all of that paperwork, but maybe it would be doable with fewer pt's. (I'm an LPN, & have enough paperwork do deal with. I don't know how you guys manage it!) You are still doing paper charting? I thought everyone was computerized now. Good luck!