Hello everyone! I love wound care, but am in the midst of a puzzle. I admitted a 50-something year old man with liver failure. Hx of etoh and Hep C. So he has a dehiscence post I&D of his right hip. On the surface the wound looks good, maybe 3cmx2cm. But upon cleaning with sterile q-tip I find the wound tunnels and is more like 13cmx 8 cm. It is having copious amounts of yellow drainage, starting to smell infected. We are restarting an ABX that was stopped before he came to us. He is in a facility, and in the past I have treated non-healing wound with lots of drainage with Dakin's solution, but the facility says that is against their policy.
The problem is that this wound is having to be change 2-6 times a day to manage the drainage, and it is cost prohibitive with dressing changes that frequent to use any of our more standard wound care products (facility recommended aquacel AG or Maxorb AG).
I am hoping someone out there will have some cost-effective recommendations on how to manage this wound. Thanks!
Well....don't feel like getting into a back and forth....NO we are not responsible for paying for medications not related to the diagnosis....but we are supposed to cover any medical supplies the Pt needs. Or, at least that's what MY HOSPICE does. Now, facility patients are a little different, maybe. But, a home Pt, yes we cover all supplies...related or not (DME, incontinence supplies, supplements, wound/colostomy care supplies).
Which a lot of times, it is related. Or, they can make it related. Say a CA Pt gets a bedsore...well, the Pt is bedbound because of the CA, which means the wound is related. Just like when you do your assessment, you are not just assessing what's related to the diagnosis. You are assessing the whole person. If a CA pt has a UTI, of course, you are going to call and get an order for ABT treatment. Bottom line, with a TRULY HOSPICE PT, most things are related. The terminal diagnosis is causing a lot of the issues the Pt is having. An incontinent Pt with a diagnosis of Liver Dz is definitely going to be provided with incontinence supplies. And, we will be the ones to provide them.
Now, your hospice may not do that....but, I'm proud to say OURS DOES. We treat the WHOLE patient, not just the terminal diagnosis......
That is simply incorrect. We are not required to pay for any number of things unrelated to the terminal diagnosis.
Believe it or not, sometimes the "old faithful" dressings do just as good, if not better, than all the new fancy ones out there. However, I would not use Dakins for more than 7-10 days. It causes too much trauma to the tissue....
NC29mom, ASN, LPN, RN
320 Posts
Well....don't feel like getting into a back and forth....NO we are not responsible for paying for medications not related to the diagnosis....but we are supposed to cover any medical supplies the Pt needs. Or, at least that's what MY HOSPICE does. Now, facility patients are a little different, maybe. But, a home Pt, yes we cover all supplies...related or not (DME, incontinence supplies, supplements, wound/colostomy care supplies).
Which a lot of times, it is related. Or, they can make it related. Say a CA Pt gets a bedsore...well, the Pt is bedbound because of the CA, which means the wound is related. Just like when you do your assessment, you are not just assessing what's related to the diagnosis. You are assessing the whole person. If a CA pt has a UTI, of course, you are going to call and get an order for ABT treatment. Bottom line, with a TRULY HOSPICE PT, most things are related. The terminal diagnosis is causing a lot of the issues the Pt is having. An incontinent Pt with a diagnosis of Liver Dz is definitely going to be provided with incontinence supplies. And, we will be the ones to provide them.
Now, your hospice may not do that....but, I'm proud to say OURS DOES. We treat the WHOLE patient, not just the terminal diagnosis......