New Innovation to Promote Improved Quality of Life for Hospice Patients

Becky Greenwood, RN, BSN, CWOCN, Education/Quality Department, Intermountain Homecare & Hospice, South Jordan, UT and Annette Gwilliam, BSN, RN, CWCN, ACHRN, Wound Care Coordination, Envision Home Health and Hospice, Orem, UT
Problem:  Wounds are a major problem at the end of life; affecting nearly one-third of patients1. Hospice and palliative care wound management requires a different mindset than traditional wound care, yet is based on the same fundamental scientific principles. “Goals for palliative wound care are well established in the literature including: pain relief, infection prevention, exudate management, odor management, improved comfort, and enhance dignity.2,3"  Appropriate wound cleansing and wound bed preparation will decrease bacteria and necrotic tissue that cause odor, exudate, inflammation, and pain.

Importance:  There is an increased need to treat the Hospice patient’s wound appropriately. Regulatory bodies for Hospice can potentially place the agency in “Immediate Jeopardy.” If inappropriate treatment of wound palliation is discovered the agency can be shut down. More important is that inappropriate wound care contradicts the very mission of providing Hospice Care.

Proposed Solution:  Replace coarse, scratchy gauzes and washcloths with a monofilament wound preparation device (MWPD).  Perform the procedure 1-2 times weekly for 2-5 minutes using saline or hypochlorous solution.  We incorporated MWPD into all Hospice wound care order sets as a standard of care for wound and peri-wound cleansing to enhance wound palliation. 

Results:  Patient “A” was a 78 y.o. female with such extensive odor and drainage that the assisted living staff would not enter her room.  We implemented MWPD with hypochlorous acid and within one week the odor was eliminated and the drainage significantly decreased.  Patient “B” was a 53 y.o. female with a painful, draining wound.  By implementing MWPD, the wound bed was cleaned and it began to heal.  After these successes MWPD has been used on dozens of patients with the same positive outcomes.

Conclusion:  Although our results are mainly subjective and qualitative, incorporation of this procedure has enhanced our patient’s Hospice care, dignity, and quality of life.