BY: NANCY MORGAN, RN, BSN, MBA, WOCN, WCC, CWCMS, DWC
The World Health Organization defines palliative care as care that affirms life and views death and dying as part of a normal process, intends neither to speed nor delay death, provides relief from pain and other distressing symptoms, and offers support to the patient and family.
With palliative care patients who have wounds, we change our focus from what may be best for the wound to what’s best for our patient. We view the patient in a holistic manner. Our goal is to give the patient control, facilitating the highest level of independence, dignity, and comfort. Or secondary goals may include healing the wound, preventing decline of the wound, preventing infection, managing odor, controlling exudate, and providing adequate pain control.
As wound care clinicians, we want to disrupt these patients as little as possible. Selecting appropriate dressings to heal the wound or prevent further decline are vital. Managing odor and exudate helps our patients maintain dignity, and using dressings that help control odor, such as charcoal dressings or even a wound management device, can be very helpful. If the odor comes from a high bacterial level causing necrotic tissue on the wound bed, debridement may be needed. With palliative care or end-of-life patients, the preferred debridement method is autolytic debridement.
Pain control is also extremely important in these patients. Anticipating a dressing change not only can cause undue anxiety but heighten the patient’s sense of perceived pain as well. Using contact layers in the wound bed may help if the dressing is adhering to the wound bed and causing pain on dressing removal; pain medication may be required as well. Be sure to wait an appropriate amount of time for pain medication to take effect. With parenteral pain medication, wait at least 15 or 30 minutes. With oral medication, wait at least 1 hour.
Does your care setting have specific wound care policies for palliative care patients? Are specific interventions in place to help protect these patients’ fragile skin? Do you adhere to recommended time frames for pain medication? Have you seen a Kennedy terminal ulcer in your practice?
DISCLAIMER: All clinical recommendations are intended to assist with determining the appropriate wound therapy for the patient. Responsibility for final decisions and actions related to care of specific patients shall remain the obligation of the institution, its staff, and the patients’ attending physicians. Nothing in this information shall be deemed to constitute the providing of medical care or the diagnosis of any medical condition. Individuals should contact their healthcare providers for medical-related information.