WOUND CARE for end of life/hospice/palliative care

[nurselearner]

How do you change your treatment plan for patients who are end of life. I know if they are actively dying it is all about comfort but what about patients who are not in the last few days of life, who may have months to live, who have infected wounds or stage 3 wounds - or chronic wounds................. the goal is not necessarily cure but....

Do you change your treatment plan- what about cost containment when it is paid through the hospice benefit rather than insurance.

what are you using, doing etc

[TrudyRN]

Well, if we just let them go, the patient will be miserable. Of course, the insurers will be happy, as the patients will be off of their bill sooner. Sorry, I am a big fan of insurance companies or of hospital exec's and Boards of Directors who short staff and short supply us.

I don't know the specifics of the hungry beast called Profits at your place so you probably need to start there and see what the rules are in that regard. Then match your nursing care to it and do what good you can for your patients.

[Sabby_NC]

We treat decubitus as best we can depending on the stage and dressing required.

If they need debriding we do this purely to keep the odor down.

Obviously patient comfort is paramount so we change dressings, keep them clean and treat as necessary.

You are right we cannot cure but we can treat as long as we need to depending on benefit versus burden and trajectory of illness.

Actively dying patients still need those comfort measures and if changing dressings will assist in this then we do what we need too eh?

Our Plan of Care has skin care, you change it to ensure wounds are kept clean etc but obviously the goal is not to have the thing healed up because that is out of the question in these immunosupressed or cachectic patients.

All about comfort comfort and comfort.

[mahoganybbw]

As a hospice LPN in the state of AZ i have had the pleasure of treating stage IV decubs on patients. Although it depends on your hospice orgainization I have assisted patients to go to wound clinics at least one time for a consultation and then continued with reccomendations that clinic made. Some hospice organizations may or may not agree to cover this expense but i think it is totally up to the CM and LPN to advocate for the best treatment for the patient....It is still about comfort and quality of life.

[lsyorke, RN]

A good comprehensive article on this here:

http://endoflifecare.co.uk/journal/0101_palliative.pdf

[WV_heart_RN]

i worked for a hospice organization that had an np who did wound consults for them. we called her and she would go see that patient and give us recommendations for care. the trick was to get the products that the patient needed when the higher ups said you were using to many items on that one patient