Palliative care is defined by the World Health Organization (WHO) as an “approach that improves quality of life in patients and their families facing the problems associated with life-threatening illnesses”. 1 Palliative care focuses on prevention and relief from suffering, providing pain control, spiritual support and symptom control, done with respect for cultural differences and individual needs. Care decisions should be made through a process that involves open dialogue between patient, family and caregivers. 1
What do we know about wounds that occur at end of life?
The skin is the largest organ of the body and is vulnerable to wound development when the organs begin to fail. End of life wounds include pressure injury, ischemic wounds and Kennedy ulcers. 3 In 2009, Skin Changes at Life’s End (SCALE) was a concept introduced to describe end of life wounds. 4 These ulcers are considered unavoidable especially in immobile patients at the end of life. Management of wounds should focus on patient comfort and minimizing the impact of the wound on quality of life, not necessarily healing wounds. 2 However, palliative care does not imply less care or lack of care, but may change the focus to more emphasis on patient comfort and prevention of new ulceration formation. 2
Where does wound care begin?
As for any patient, good skin and wound care begins with a comprehensive assessment including a risk assessment, and wound assessment. 2 These individuals will also require a comprehensive pain assessment and discussion of quality of life and personal choices. Care should be coordinated between the patient, family and caregivers with the patient’s comfort taking precedence.
How to manage pain and exudate?
Wound pain is often experienced during dressing changes. The wound surface is fragile, and adherent dressings or crusted, dry exudate can be traumatic to the wound during dressing removal and result in significant pain for the patient. 3 Gauze dressings have been found to be more painful due to granulation tissue growing through the porous gauze material evoking pain and trauma with
dressing changes. 3 Careful selection of dressings and utilization of dressing material such as silicone, foam, alginate or hydrocolloid dressings will help to manage exudate and control pain.
Are there other concerns?
Odor from wounds can have a significant impact on the quality of life for the patient. Odors can increase patient stress and embarrassment, resulting in depression and a decreased quality of life. 1 Odors are often a result of increased bacteria in the wound or wound dressing. When odor persists, antibiotic therapy or dressings designed to reduce microbial contamination may be needed. Dressings with silver have been found to be effective in reducing odor producing microbes in the wound environment. 3
How can DermaRite help?
DermaRite’s skin and wound care products help caregivers meet the needs of even the most challenging wound conditions. DermaGinate, our calcium alginate dressing line, is designed for moderate to highly exuding wounds. DermaGinate conforms easily to the wound bed and acquires a soothing gel-like consistency when in contact with moisture and exudate, yet maintains its integrity for ease in dressing removal. DermaGinate AG contains silver to protect against microbial contamination of the dressing, minimizing odor. Both DermaGinate and DermaGinate AG are available in pad and rope forms.
- Burt T. Palliative care of pressure ulcers in long-term care. Annals of Long-Term Care: Clinical Care and Aging. 2013; 21(3):20-28.
- National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline. Emily Haesler (Ed.) Cambridge Media: Perth, Australia 2014
- Palliative wound care management strategies for palliative patients and their circles of care. Clinical Management, 283, 130-141.
- Krasner, D. (2015, 04). SCALE wounds: unavoidable pressure injury. medscape.com. Retrieved 10, 2016, from http://www.medscape.com/viewarticle/844514