End of Life Does Not Mean End of Care: Development of a Palliative Wound Care Guideline in an Acute Care Hospital

Problem: There is often a lack of understanding as well as different interpretations as to what palliative wound care actually means.  A review of the literature reveals that the interventions and goals of palliative wound care fall within 3 major categories: controlling pain, wound management and achievement and maintenance of an optimal quality of life for the patient, caregiver and family.  At Stony Brook University Medical Center, a 575 bed Level I Trauma Center, the development of a standardized palliative wound care guideline was deemed essential in providing quality medical/nursing care to those with non healing wounds as well as those receiving end of life care.                                                     Methods:                                                                                                                                                                                                                                                                                                                          Phase I: An interdisciplinary palliative wound care task force was created encompassing WOC nurses, an oncology clinical nurse specialist, palliative care nurse practitioners and nurse educators.  A comprehensive review of the literature was conducted and an evidence based wound care guideline was developed based upon current practice recommendations.    Phase II:  To perform a Mixed Methodology study (quantitative and qualitative measurement) of wound pain assessment, wound measurements and patient/caregiver satisfaction on a 30 bed, Hematology Oncology Unit.  Inclusion criteria:  Patients who have been placed on comfort care measures and /or have a malignant or non-healing wound(s).                                                                                                                Goal: With the initiation of the SBUMC Palliative Wound Care Guideline we hope to demonstrate that adhering to a standardized plan of care will show measureable improved wound care outcomes; wound related pain control, and an increase in patient/caregiver satisfaction.