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+++++++++++++++++++++++++++++++ + + +++++++++++++++++++++++++++++++ CARING FOR THE ELDERLY +++ +++ W Effective I ound Care P s Integral in alliative Care is placed on managing symptoms (pain, nausea, constipation, despair, fear, confu- sion, depression, shortness of breath) and the indecision many patients and families face when someone is seriously or terminally ill. It is effective in a wide array of treatment settings (hospital, acute care, home, etc.) is used in conjunc- tion with other medical treatments for a wide variety of serious chronic diseases (dementia, heart failure, COPD, renal failure, Parkinson's disease, multiple sclerosis and cancer). One aspect of effec- tive palliative care is making the patient as comfortable as possible. This makes effective wound care a high priority. Unfortunately, as patients age and/or their illness progresses, they become less active and consume less food, making it diffi cult for them to meet their body's nutritional needs. As a result, despite the best preventative efforts from staff, they may develop pressure ulcers which require aggressive treatment to heal. An effective palliative wound protocol P starts with: ALLIATIVE CARE IS based on improving the quality of life and, in many cases, increasing the quality of life.1 Emphasis By R. Daniel Cevasco, MD + Impeccable skin lubrication (make them shine!). + Should a wound develop, treat it with viscous lidocaine. This not only helps seal the wound, but also relieves pain and makes the patient more comfort- able while the wound is healing. + The recommended support surface for patients is the static air overlay, which is considered a group one mattress under Medicare. The static air overlay "fl oats" the patient, signifi - cantly decreasing the pressure points throughout his/her body. A six-year study published in 2009 by Dr. A. Tippet reported a 99 percent decrease in facility-acquired pressure ulcers as well as a surprising 40 percent decrease in falls attributable (we believe) to increased patient comfort.2 cost benefit for nursing facilities is also impressive. The Using the simple techniques in this protocol, facilities can prevent nearly all pressure ulcers. And, if wounds are present upon a patient's admission, using these techniques can save a facility more than 50 percent on overall wound supply costs. Effective prevention includes: + Identifying patients at risk for pressure ulcers + Aggressive lubrication techniques + Adequate nutrition to encourage wound healing + Regular repositioning of the patient to prevent skin irritation + Use of appropriate support surfaces such as a static air overlay The treatment plan may vary a bit, depending on the severity of the ulcer. References 1. Journal of Pain and Symptom Management, Vol. 33, #3, March '07 2. "Reducing the Incidence of Pressure Ulcers in Nursing Home Residents: A Prospective 6-year Evaluation" Ostomy Wound Management, November 2009 Dr. Daniel Cevasco is associate medical director of Summa's Palliative Care and Hospice Services. n 22 | Cleveland-Akron-Canton MD NEWS MDNEWS.COM NOVEMBER-DECEMBER 2011