Providing wound care for hospice patients is an important aspect of delivering comprehensive, end-of-life care.

While some hospice services have wound care specialists on staff or access to on-call, contracted wound care services, others do not.

Hospice providers without wound experts on staff often try to manage patients’ wounds on their own, said Joni Brinker, MSN/MHA, RN, WCC.

Brinker is an Ohio-based consultant and clinical nurse educator with Optum Hospice Pharmacy Services of Eden Prairie, Minn.

They only summon a wound care specialist if a problem develops, she added.

“It’s rare to see a dedicated wound care specialist in hospice,” Brinker said. “Wound care is usually performed by the primary nurse, a case manager, or someone in the organization who’s more comfortable with wounds and wound care.”

Last Resort Calls Are Tough

A fair number of hospice staff and nurses have very little experience in hospice wound care.

“This lack of experience regarding tissue and exudate types is why sometimes the calls come to us later rather than earlier,” Brinker said.

Some examples of situations that prompt later calls to consultants like Brinker include wounds that are malodorous, infected, and those with heavy exudates.

“Many times, we are called as a last resort, after several other treatment approaches have been tried with no results and they don’t know what else to do,” she said.

When a wound reaches that point, it requires a more intensive treatment approach, Brinker said.

“If a wound care specialist is called in earlier, rather than later, it’s better for the patient, their family, and the caregivers,” Brinker said.

Some hospice providers do call Brinker early on for their patients, she said.

“We also receive consult requests soon after a hospice admission,” Brinker said. “Some examples are for wounds with a drain or wound vac or fistulas.”

Organizational Strategies for Better Hospice Wound Care

1. Conduct an initial assessment upon arrival

Ideally, Brinker recommends wound care specialists see patients when they arrive at hospice. Then the specialist can conduct an initial skin and wound assessment.

“This would take the burden off of the untrained hospice nurse or case manager who may be unfamiliar or uncomfortable with these assessments,” she said.

Brinker suggests organization leaders review hospice wound care policies and procedures. This ensures they are up-to-date and meet current wound care standards.

It’s also important to develop an organizational formulary regarding wound care products.

According to Brinker, an organization’s wound care product formulary should include:

  • Names of various wound care products
  • Instructions for appropriate use
  • Identification of user-friendly products
  • Explanation for product and use is evidence-based

2. Update patients on the plan of care

When teaching wound care to healthcare professionals, Brinker highlights the fact that too often, many clinicians take their patients out of the equation.

“It’s important we teach patients, families, and caregivers about the wound care plan, the products we recommend and why, and what products we are currently using,” she said.

When treating chronic wounds, Brinker said it’s also crucial to understand what patients, family members, and caregivers like or dislike about the wound care plan and the products being used.

One example illustrating the importance of tailoring hospice wound care and products to the patients’ needs is product wear time.

“Patients who are ambulatory and get out of bed to shower every day, many times prefer dressings with a shorter wear time, so they can put on a fresh dressing after they shower each day,” she said.

On the flipside, choosing a dressing with a longer wear time for patients who are bed bound may better suit their needs and the needs of their caregivers, Brinker said.

Another essential practice is asking patients about their levels of comfort, pain, and anxiety.

“This can also help you during the dressing selection process and help you choose dressings that are best suited for each patient,” she said.

3. Clinicians must stay current on wound care

Brinker encourages clinicians working in hospice to learn as much as they can about wound bed preparation.

“I advise nurses and others I work with and teach, to read a lot of articles on wound care and wound bed prep,” Brinker said. “Learn as much as you can about the different types of dressings available and the types of wounds they are recommended for. You’ll also want to review manufacturer provided information regarding what products are best suited for various wounds.”

For Brinker, sticking to the basics of wound care is important when working with wounds.

“You’ll want to focus on tissue management which includes performing debridement as needed, assessing for and controlling inflammation and infection, managing exudates and balancing moisture, monitoring the epithelial edge and checking for epibole.”

For some patients, the goal of hospice wound care may be to promote healing of a wound – and this is possible in some cases, said Brinker.

“For other patients, having a goal of healing a wound is not realistic and may not be possible,” she said.

“When that’s the case, the goal is managing and stabilizing a wound to help minimize the patient’s pain and improve their quality of life as much as possible.”

Being honest with a patient regarding the expected trajectory of a wound and its ability to heal or not is essential, Brinker said.

Discover the many benefits of a WCEI wound care certification today.

Carole Jakucs, MSN, RN, PHN, CDCES

Carole Jakucs, MSN, RN, PHN, CDCES, is a freelance writer and diabetes educator. Her background in nursing includes tenures in healthcare management and as a care provider. She has worked in med/surg/telemetry, a pediatric emergency department and college health.

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