Palliative Care Order Set - Stratis Health

Palliative Care
Annotations Committee on Evidence-Based Practice/May 6, 2008
• To control exudate
- Autolysis: hydrocolloid dressings
- Enzymatic: applied to devitalized areas to accelerate debridement
- Mechanical: wet-to-moist dressings, whirlpool, irrigation
- Sharp: devitalized tissue removed manually either at the bedside or in the operating room
• To control odor
- Kitty litter or activated charcoal: place in dish or tray under bed
- Peppermint oil or other aromatherapy products
- Metronidazole
• Topical: apply 0.75% cream or gel or or sprinkle crushed tablet directly to wound daily
for 7 days, then evaluate
• Systemic: 500 mg by mouth three times daily for 7 days, then evaluate
- Silver sulfadiazine cream, apply to wound daily as needed
- Activated charcoal dressing (various manufacturers), use according to package directions
Consult wound care specialist or enterostomal nurse specialist for complicated or poorly responding
wounds.
Malignant Wounds
Clarify specific goals for wound care; this will influence choice of treatments. In the patient with an expected
survival of days to weeks, the clinician may choose to focus on palliation of distressing symptoms rather than
wound healing. Complementary therapies such as music, acupuncture, visualization and guided imagery
often enhance patient comfort (McDonald, 2006 [M]; Schim, 2005 [R]).
Orders
• Premedicate with short-acting opioid analgesic 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
• To control pain
- Systemic opioids (see Annotation #17)
- Morphine 1 mg in 1 gm hydrogel, apply directly to wound surface daily (Eisenbud, 2003)
• To control exudate
- Hydrocolloid dressings
- Foam dressing
- Alginate (avoid in bleeding wounds)
- Ostomy appliance
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