SuperHawk Asked May 2020
Any practical advice for a total novice on wound care for unstageable pressure sore management?
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He needs proper wound care Doctor, treatment nurse, and nursing assistants. He needs a team.
Take pictures, take pictures.
As a Medicare patient your dad has rights. As a patient he has rights. Complain to Medicare.
Go to a health oriented store, ie Trader Joe's, Natural Grocers, even a farmer's market and buy RAW honey. It will be a bit cloudy because it is not processed and it is expensive, but a little bit goes a long way. Be prepared to pay around 10.00 a cup.
I discovered that not everything labeled as honey really is when treating a skin rash on holiday. I ran out and picked some up, needless to say that all healing came to a screeching halt, that is how I discovered the fraud.
You wrote the magic words: HMO, rotating doctors assigned by the HMO.
It might be costly to get Medicare now, but please do consider it.
And even though the HMO assigns the doctors, you still have a right to criticize, or call an Ombudsperson. And I would do that.
I am looking into getting an ombdusperson if they try to discharge him to an unsafe skilled nursing facility without consulting me. I hope the SNF know better and tell them not until his sacral sore is not addressed medically. I do not think dad is getting antibiotic therapy to avoid sepsis. They are with the wait and see approach. Very mean system.
What turned the corner for her was Procellera. It is gauze with tiny metal dots on it that, when exposed to moisture (like sterile water or saline), creates a small electrical charge. This stimulates the blood supply and promotes healing. My sister was the first patient in our city to use it, with the approval of her wound care doctor. We bought it directly from the company because it was a new product that had recently been approved by the FDA. I believe it is more readily available now and may be covered by insurance. (I don't work for them, but the product worked for my sister and I have told many people about her success using it.)
Sounds incredible. A charged dressing.
I hope your sister will continue well. Were these private consults or through insurance? Access to consult with 2 different doctors sounds luxurious.
With an HMO once you select medical group you can only have doctors under that umbrella for coverage. Asking for second opinion among them will certainly have conflict of interests. Second guessing colleagues is something not covered so it is never brought up I suppose.
I think the Hospital doesn't want to admit its their fault. It can be considered abuse. Get someone to order an in home wound care nurse.
When my father makes it back home I need to make sure someone VERY specific oversees his decubiti. Or are all rn's knowledgeable and trained enough?
I shiver thinking of dad's actual wound state. No one can answer anything. Almost as if they were under a gag order. I am so afraid for him.
The size of the largest ulcer is to me indicative of need for medical treatment in a hospital, or perhaps even a rehab center. I think this doctor may be thinking of his "quick discharge" score in wanting to send your father home.
I'm shocked that there are 9 areas of concern, not to mention the size of the sacral wound. Could you provide some background how these occurred? Is your father primarily sedentary, limited in mobility, and spent a lot of time sitting or laying down?
What was the cause that prompted hospitalization?
I am definitely not criticizing, just inquiring. His conditions at home could provide insight into how the ulcers developed and contribute to an appropriate curative plan. I'm also wondering if he's diabetic?
You are aware I hope that you can ask for a different doctor? I did that when a hospitalist and two young things with little people experience outstepped their bounds. I don't recall if I approached the Charge Nurse, or called the hospital Administrator, but I got rid of the insensitive ones and got a doctor who focused on elderly care.
He was much more sensitive; although he was also frank, he was professional in addressing the issues, unlike the "baby doctor" who still needed to learn how to deal with older people.
Shane is very insightful and I anticipate will have more questions and advice.
It has been 3 weeks since admission and yesterday nurse informed there are now 9 pressure points plus sacral is 10-15 cms.
Is it normal to be in hospital with 3 nurse shifts and have that many and sacral expanding? I read wound care is very expensive. Is that why they are expecting me to accept there is nothing more to do?
Not even rotating him??
Diagnosing this would mean they’ve done some sort of evaluation.
Is it unstageable because it is not an open wound? Usually unstageable pressure ulcers are open wounds or can’t be measured for depth/width/length. Stage 1 is redness around an area With no open areas (yet). In order to be classified as unstageable the wound needs to be evaluated by a MD as they measure depth/length/width. When I was a HC RN we measured the wound weekly to assess for healing.
Did a wound specialist see the pressure ulcer while dad was in the hospital?
If it’s unstageable and no one has seen it, how could someone write woundcare orders?
Now dad will have to see a woundcare specialist to determine treatment. Then homecare will get ordered for woundcare if needed.
A physician needs to write homecare orders & specify woundcare to be completed and homecare orders the supplies designated by the doctor. Nurses can assess the wound but not write woundcare orders (unless they are PA’s or NP’s).
I can’t believe that doctor just discharged him with no instructions. Usually a nurse will come and explain discharge orders to a patient, not the doctor. Did anyone discuss this with nursing on dad’s discharge?
Change his position every two hours. Get an order for an alternating air mattress for his bed while he is sleeping.
Make sure he gets protein in him to promote tissue healing.
What does his wound look like now? As a nurse I am curious.
If you can find it, there is a protein drink called Juven. It is supposed to help with healing after surgery; my sister drank it while recovering from her most recent pressure wound.
Make sure your dad gets extra protein.. Ensure, lots of protein, for some reason someone told me that it helps because the body needs protein to heal...??
If dad got it in hospital,,the doctor knew it and knew you didn't know how fast and bad these things get..
rotate every 3 hours. keep him off that spot.. clean bandages.
I would write a report stating specifically what happened and send it to the hospital, the AMA and the states governing body for doctors, this doctor needs to go mop floors.
You say I ought to call the hospital but for me the hospital belongs to this medical group. I don't think there is a hospital manager.
Discharged from a US hospital? Call the patient advocate tomorrow and report this.
AFTER you get the doc to prescribe home care services, of course.
I would call him back and ask for a script for home care, for a nurse to assess and provide in home wound care. Start researching and contacting home care agencies to decide on one to choose, as it is your choice, not the doctor's.
If he won't do that, try to find a wound care specialist or wound care clinic. In my area, large hospitals sometimes have special wound care clinics.
To infer that he's old and not provide care is to me irresponsible. Even if he's old, wound care would make his life safer.