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Wounds at End of Life

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NRSKarenRN, BSN, RN

Specializes in Vents, Telemetry, Home Care, Home infusion. Has 44 years experience.

I was suprised by the high number 1/3 of all hospice patients having a wound.

That has not been my experience in hospice.

Those patients mostly staying in bed are all given low airloss mattress if in a hospital bed. Others lying on sofa or own bed provided with eggcrate mattress if limited turning. Repositioning strongly emphasized along with lotion to skin. Maybe that's why less than 10% our patients had wounds.

I was suprised by the high number 1/3 of all hospice patients having a wound.

That has not been my experience in hospice.

Those patients mostly staying in bed are all given low airloss mattress if in a hospital bed. Others lying on sofa or own bed provided with eggcrate mattress if limited turning. Repositioning strongly emphasized along with lotion to skin. Maybe that's why less than 10% our patients had wounds.

my first and only thought was these pts had not been repositioned.

it has been my understanding that medicare will not pay for low airloss mattresses unless they had a minimum of a stage III decub.

but between the body/immunity system shutting down, probable malnutrition and not being repositioned would more than likely be the causative factors.

leslie

There may be another factor...they may have become hospice patients BECAUSE they had wounds, at least the ones who were nursing home patients. When the nursing home brings hospice in and the patient is declared to be terminal, then the state has different expectations for the wound care. The nursing homes may have been trying to avoid being dinged by the state when they made those referrals.

seasonedlpn

Specializes in Home Health, Hospice.

some of our hospice patients have surgical incisions that have not healed. More than once I've encountered radiation burns. I currently have a hospice patient with a cancerous growth at the ankle. It's an open, draining tumor that bleeds profusely if jostled. frequently a cancer will manifest externally.

Life: A sexually transmitted, terminal condition.

Our hospice will not pay for a low air loss mattress unless in an extreme circumstance. Neither would the hospice that I used to work for. We routinely cover APP mattresses, though. I often see a stage 2 on a patients sacrum 2-3 days before they die, mainly because the family does not want to turn them in that state.

SwinkerDoodleRN

Specializes in Pediatric Intensive Care, Day Surgery. Has 3 years experience.

Im so proud of our LTC facility. We turn patients Q2H and we have a 100% heal rate for any wounds that our patients are admitted here with.

Our hospice will not pay for a low air loss mattress unless in an extreme circumstance. Neither would the hospice that I used to work for. We routinely cover APP mattresses, though. I often see a stage 2 on a patients sacrum 2-3 days before they die, mainly because the family does not want to turn them in that state.
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