Palliative Care Order Set - Stratis Health

Palliative Care
Annotations Committee on Evidence-Based Practice/May 6, 2008
(National Pressure Ulcer Advisory Panel, 2007 [R])
Wound dressings serve several purposes:
• Protect the wound bed from trauma, infection
• Promote removal of exudate and necrotic tissue
• Provide moist healing environment
(von Gunten, 2005b [R])
The appropriate dressing may change based upon the healing of the wound. See Appendix A, "Common
Dressings for Pressure Ulcer Treatment."
Approach to managing pressure ulcers
• When skin is intact, relieve pressure and address other factors, within the context of the patient's
goals of therapy.
• Premedicate with opioid analgesic before wound cares and dressing changes
• Short-acting systemic opioid for pain before wound cares and dressing changes
• Cleanse by gentle irrigation with preservative-free normal saline or with non-cytotoxic wound
cleaner
- 18 to 20 gauge angiocath on 30 to 60 mL syringe
• Distinguish between colonization and infection
- Diagnosis of infection made based on clinical indicators, e.g., pain, induration, exudate, fever
and leukocytosis
- If infection present, culture results may guide appropriate antibiotic selection
For a clean open area
• Cover to keep wound base moist
• Loosely pack dressing material (e.g., hydrogel, alginate) into dead space to absorb exudate and
maintain moist environment
(Eisenbud, 2003 [R])
For a wound with necrotic or fibrinous material in the base, or eschar
• Heel eschars can be left alone as long as eschar is intact, with no evidence of drainage or infection
• Other sites: Choose debridement method based on extent of wound, comfort of patient, and goals
of therapy
• To control pain
- Systemic opioids (see Annotation #17)
- Morphine 1 mg in 1 gm hydrogel, apply directly to wound surface daily
Institute for Clinical Systems Improvement
www.icsi.org
33