Palliative Wound Treatment Promotes Healing
This is a retrospective observational chart review of 2 different cohorts. Study A included 192 hospice patients with 323 wounds treated over 30 months; Study B included treatment of 156 pressure ulcers and other wounds in 72 nursing home patients over 12 months. Study A is from previously published data and results; the current report details specific treatment not covered in the previous report.
Study A consisted of 192 hospice patients with 323 wounds treated over a 30-month period. Types of wounds included pressure, neuropathic, ischemic, and other. Wound treatment selection was determined by hospice physician recommendation and patient/caregiver consent. Consent was obtained as part of standard practice for any treatment offered. With patient or caregiver permission, wounds were treated with the mixture of lidocaine and topical antibiotic, moistened as needed with normal saline, and applied on a gauze to fit the wound. Wound dressings were either changed daily, less frequently if the wound was dry, or more frequently if there was heavy drainage. Not all patients or caregivers gave permission for use of this treatment; some were afraid of using lidocaine in the wound, some did not perceive it as aggressive treatment, and some thought it seemed too unusual to work. Therefore there were 92 (28%) wounds treated with another modality based on their physician's orders, including various types of dressings such as wet-to-dry, hydrocolloids, alginates, or vacuum-assisted closure (VAC). The new method, which will be referred to as the novel dressing, was used to treat 231 (72%) wounds. Ninety-two wounds were treated with other methods. Wound healing was determined by the traditional method of measuring length and width, evaluating the amount of drainage, and assessing the wound tissue for granulation, slough, or necrosis. A wound was considered to be healing if it showed contracture with granulation and decreased size. Wounds were assessed weekly by a nurse, and every 1–3 weeks by the hospice physician. Since the palliative goals of care were to relieve pain, control odor, and prevent infection, these parameters were evaluated with each assessment. Since the majority of patients were nonverbal no analog scales were used; evaluations depended on nursing assessments. Pain assessment was made by observing patient facial expression, body movement, and noting if the patient moaned or cried during treatment.
This method provided a primary wound dressing, but a secondary dressing was usually needed. In keeping with the desire for simplicity and maintaining comfort, the top dressing was provided by applying a thick layer of zinc oxide ointment around the wound with a sheet of plastic wrap placed on top and pressed into the zinc oxide ointment.
As stated, use of this treatment method expanded from hospice to non-hospice in the wound center of a long term care facility (Clovernook Health Care Pavilion, Cincinnati, OH) which used it exclusively. Over a 1-year period in this nursing home, 156 wounds—including venous, diabetic, surgical, ischemic, and stage 2–4 pressure ulcers—in 72 patients were treated with the lidocaine and antibiotic mixture on gauze, which was changed daily. Some of these patients actually were in hospice, but not identified in Study B. Wound healing was judged by the traditional method of measuring length and width, evaluating the amount of drainage, and assessing the wound tissue for granulation, slough, or necrosis. A wound was considered to be healing if it showed contracture with granulation and decreased size. Pain and odor were also observed, but not reported in Study B. Wounds were assessed weekly by the wound nurse, who held wound care certification (WCC) from the National Alliance of Wound Care and Ostomy, and every 1–2 weeks by the director of wound care for the nursing home. Wounds were followed to closure. In this nursing home, all patients with wounds also had static air pressure support with mattress overlays and chair cushions (EHOB, Inc, Indianapolis, IN). This data was from nursing home wound records, and was not published.
Materials and Methods
This is a retrospective observational chart review of 2 different cohorts. Study A included 192 hospice patients with 323 wounds treated over 30 months; Study B included treatment of 156 pressure ulcers and other wounds in 72 nursing home patients over 12 months. Study A is from previously published data and results; the current report details specific treatment not covered in the previous report.
Study A
Study A consisted of 192 hospice patients with 323 wounds treated over a 30-month period. Types of wounds included pressure, neuropathic, ischemic, and other. Wound treatment selection was determined by hospice physician recommendation and patient/caregiver consent. Consent was obtained as part of standard practice for any treatment offered. With patient or caregiver permission, wounds were treated with the mixture of lidocaine and topical antibiotic, moistened as needed with normal saline, and applied on a gauze to fit the wound. Wound dressings were either changed daily, less frequently if the wound was dry, or more frequently if there was heavy drainage. Not all patients or caregivers gave permission for use of this treatment; some were afraid of using lidocaine in the wound, some did not perceive it as aggressive treatment, and some thought it seemed too unusual to work. Therefore there were 92 (28%) wounds treated with another modality based on their physician's orders, including various types of dressings such as wet-to-dry, hydrocolloids, alginates, or vacuum-assisted closure (VAC). The new method, which will be referred to as the novel dressing, was used to treat 231 (72%) wounds. Ninety-two wounds were treated with other methods. Wound healing was determined by the traditional method of measuring length and width, evaluating the amount of drainage, and assessing the wound tissue for granulation, slough, or necrosis. A wound was considered to be healing if it showed contracture with granulation and decreased size. Wounds were assessed weekly by a nurse, and every 1–3 weeks by the hospice physician. Since the palliative goals of care were to relieve pain, control odor, and prevent infection, these parameters were evaluated with each assessment. Since the majority of patients were nonverbal no analog scales were used; evaluations depended on nursing assessments. Pain assessment was made by observing patient facial expression, body movement, and noting if the patient moaned or cried during treatment.
This method provided a primary wound dressing, but a secondary dressing was usually needed. In keeping with the desire for simplicity and maintaining comfort, the top dressing was provided by applying a thick layer of zinc oxide ointment around the wound with a sheet of plastic wrap placed on top and pressed into the zinc oxide ointment.
Study B
As stated, use of this treatment method expanded from hospice to non-hospice in the wound center of a long term care facility (Clovernook Health Care Pavilion, Cincinnati, OH) which used it exclusively. Over a 1-year period in this nursing home, 156 wounds—including venous, diabetic, surgical, ischemic, and stage 2–4 pressure ulcers—in 72 patients were treated with the lidocaine and antibiotic mixture on gauze, which was changed daily. Some of these patients actually were in hospice, but not identified in Study B. Wound healing was judged by the traditional method of measuring length and width, evaluating the amount of drainage, and assessing the wound tissue for granulation, slough, or necrosis. A wound was considered to be healing if it showed contracture with granulation and decreased size. Pain and odor were also observed, but not reported in Study B. Wounds were assessed weekly by the wound nurse, who held wound care certification (WCC) from the National Alliance of Wound Care and Ostomy, and every 1–2 weeks by the director of wound care for the nursing home. Wounds were followed to closure. In this nursing home, all patients with wounds also had static air pressure support with mattress overlays and chair cushions (EHOB, Inc, Indianapolis, IN). This data was from nursing home wound records, and was not published.
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