When comfort is the goal of wound care
Near the end of life, skin often breaks down despite attentive care, and wounds that might once have been treated toward closure are managed for comfort instead. The questions change. Can the dressing be changed less often? Can odor be controlled so the family can sit close? Can drainage be contained, and can dressing changes hurt less?
Wound care support for hospice and palliative teams is organized around those questions. Gateway arranges visits by partner clinicians in homes and facilities across Greater St. Louis and the Metro East and coordinates the scheduling, records and communication. The treating clinician makes wound decisions within the goals the patient, the family and your team have set. Our page on palliative wound care describes the approach.
Situations where a wound consult can help
- Cancer-related wounds with heavy drainage, odor or a tendency to bleed.
- Pressure injuries in a patient who can no longer be repositioned comfortably.
- Dressing changes that are painful or distressing for the patient or the family.
- Swollen, weeping legs in advanced heart, kidney or liver disease.
- A wound the family is struggling to manage between nursing visits.
- Uncertainty or disagreement about whether a wound can still improve.
Working inside the hospice plan of care
When a patient is enrolled in hospice, the hospice team directs the plan of care. A partner clinician’s visit is arranged only with your team’s knowledge and agreement, and coverage questions are settled with the hospice and the plan before the visit, not after.
We ask your team what the goals are, what you want from the consult, who should receive the recommendations and who supplies dressings. The treating clinician’s findings come back to the hospice nurse and physician, who decide how they fit the plan. Your nurses continue their visits and dressing changes. The aim is one plan, not a second one running beside yours.
Palliative patients who are still in treatment
Patients followed by a palliative care team outside hospice are often still pursuing treatment, and their wound goals can be mixed: heal it if possible, and stay comfortable either way. The treating wound clinician can give the patient and your team a frank view of what is realistic, which supports the goals-of-care conversations you are already having.
For these patients Gateway can also coordinate primary care with partner clinicians, including advance care planning conversations and attention to pain and comfort. Decisions about medication stay with the prescribing clinicians.
Transitions onto and off hospice
Some patients are already seeing a wound clinician when they elect hospice. With the patient’s permission, we send your team the current wound orders and recent notes, and the hospice and the treating clinician decide whether continued involvement is useful.
Other patients leave hospice with a wound that still needs attention. When your team tells us a discharge is coming, we help arrange wound and primary care follow-up with partner clinicians, subject to availability for the patient’s location.
Supporting the family at the bedside
Families often do much of the daily care, and wounds are one of the harder parts. Two guides are written for them: wound care at the end of life and what to tell the care team about wound odor. Caregivers who are worn down may also find the page on caregiver support useful.
For a patient on hospice, the family’s first call about any change is to your hospice, as you have taught them. We do not ask families to call Gateway in place of your on-call line.
How to reach us about a patient
Call 314-325-0126, or use the referral form to request a call back. The form takes contact details only. Records can be faxed to 314-786-7966.
Tell us whether the patient is on hospice or followed by palliative care, the care setting, the goals and what you want the wound clinician to address. We confirm clinician availability for the patient’s location and do not promise visit timing in advance.
Common questions
Can a patient on hospice be seen by an outside wound clinician?
It can be arranged when the hospice team wants it. The hospice directs the plan of care, so the request should come from or be approved by your team, and the visit is coordinated with your nurse. How the visit is paid for depends on the hospice, the plan, the treating provider and the care needed. That question is resolved before a visit is scheduled.
Is the aim to heal the wound or to keep the patient comfortable?
It follows the patient’s goals. For most hospice patients that means comfort: less pain, less odor, contained drainage and fewer dressing changes. Some wounds do improve with comfort-focused care, but improvement is not the measure. For palliative patients still in treatment, the treating clinician and your team may set goals that include healing where that is realistic.
Who orders and supplies dressings for a hospice patient?
That is confirmed before the first visit so nothing is ordered twice. For a patient on hospice, supplies related to the plan of care are normally a question for the hospice, and the treating clinician’s recommendations go to your team to act on. For palliative patients outside hospice, Gateway can follow up on supply orders written by the treating clinician.
What should a family do if a wound bleeds or changes suddenly?
A family caring for a hospice patient should follow the instructions your team has given and call your hospice number. For a patient who is not on hospice, heavy bleeding that does not stop, trouble breathing or a sudden change in alertness is an emergency, and the family should call 911. Gateway is not an emergency service.