Clinical Problem: 23-year-old female presented with recurrent acute myelogenous leukemia (AML) and recently underwent her second allogenic stem cell transplant. She was admitted to the hospital for Grade IV (GVHD) of her skin. She was in extreme pain, very anxious and would not allow anyone to touch her. High doses of narcotics were administered. Multiple open bullae were noted on her back, neck and chest as well as erythema multiforme.Past management included burn sheets, cleansing wounds with normal saline and applying a moisturising cream BID.

Clinical Approach: A team approach to care was utilized for this patient which included extensive pain management using Dilaudid PCA, neurontin and methadone. The WOCN nurses developed a plan of care which comprised of gently cleansing open bullae with warm sterile water. A vest of “silver contact dressing roll” was created by sewing pieces of “silver dressings” together and placed over her back, chest and neck open bullae. This vest was worn for 3 day intervals and moistened routinely with warm sterile water.

Outcomes: Within 24 hours, the patient decreased her use of pain medicine and became less agitated.By decreasing the bioburden of the bullae using the “silver contact dressing vest”, the open bullae improved dramatically without infection. Not only were we able to decrease the frequency of dressing changes but this innovative plan of care also enhanced reepitheliazation and improved the patient's quality of life.