There were between 1.5 and 1.6 million patients on hospice in 2012 according to the National Hospice and Palliative Care Organization (NHPCO 2013). Of these patients many will either be admitted with or develop wounds while under hospice care. These can have debilitating effects beyond the obvious tissue breakdown and pain most nurses associate with wounds, they can also bring psycho-social issues such as malodor and require over frequent dressing changes. These can serve as a reminder to the patient and their family of the morbidity and mortality associated with end of life care and detract from the comfort that hospice is designed to bring. The author has developed a PICOT question, 'Should wound treatments originally started for curative purposes in hospice patients suffering wounds (P) be treated in a continuing fashion to remedy the wound and prevent pain (I) or should only basic pain treatment such as analgesics (C) be used as pain develops for the greatest relief and quality of life to the patient (O) during hospice and end of life care (T)'. This will be answered by reviewing current literature and evidence based practices being proposed by Calvary Hospital and institutions such as the Centers for Medicare and Medicaid Services (CMS) and the Wound, Ostomy and Continence Nurses' Society (WOCNS). The concept of the Betty Neuman theory of holistic and flexible care will be used as a looking glass for vision and direction that care should take.

"Nurses play a vital role in improving the safety and quality of patient car -- not only in the hospital or ambulatory treatment facility, but also of community-based care and the care performed by family members. Nurses need know what proven techniques and interventions they can use to enhance patient outcomes. To address this need, the Agency for Healthcare Research and Quality (AHRQ), with additional funding from the Robert Wood Johnson Foundation, has prepared this comprehensive, 1,400-page, handbook for nurses on patient safety and quality -- Patient Safety and Quality: An Evidence-Based Handbook for Nurses. (AHRQ Publication No. 08-0043)." - online AHRQ blurb, http://www.ahrq.gov/qual/nurseshdbk/

Designed for health care professionals in multiple disciplines and clinical settings, this comprehensive, evidence-based wound care text provides basic and advanced information on wound healing and therapies and emphasizes clinical decision-making. The text integrates the latest scientific findings with principles of good wound care and provides a complete set of current, evidence-based practices. This edition features a new chapter on wound pain management and a chapter showing how to use negative pressure therapy on many types of hard-to-heal wounds. Technological advances covered include ultrasound for wound debridement, laser treatments, and a single-patient-use disposable device for delivering pulsed radio frequency.

Rev. ed. of: Acute and chronic wounds / [edited by] Ruth A. Bryant, Denise P. Nix. 3rd ed. c2007.

Background: Annually, more than 2.5 million individuals in the United States are diagnosed with pressure ulcers, leading to painful experiences, a decline in quality of life, and heightened healthcare expenses. These chronic wounds can significantly impact a patient's mobility and often reappear. Advanced chronic conditions, such as malnutrition, anemia, recurrent infectious diseases, polypharmacy, and hospitalizations, can frequently lead to pressure ulcers. The project site is a clinic specializing in wound care services, providing treatments at patients' residences or wherever they may reside, focusing on wound care treatments for all parts of the body, and accepting patients regardless of their insurance or provider status. The clinic collaborates with individuals, home health, hospice, and residential care facilities. EBP Framework: Lewin's theory of planned change and Johns Hopkins nursing evidence-based practice model worked as the framework for this quality improvement project. This project aims to improve wound healing documentation consistency. The two complement each other in identifying a problem, sorting the evidence, formulating a plan, and evaulating the outcomes to ensure continued use. Methods: This quality improvement project's main objective is to evaluate the effectiveness and usability of an assessment tool called the Pressure Ulcer Scale of Healing (PUSH), which focuses on documentation and tracking the healing rate in pressure ulcers, diabetic foot ulcers, and venous stasis ulcers at a home visit based wound care company. Once the Institutional Review Board (IRB) was obtained, provider in-service education occurred. The project participants' sample size was (n=3) comprised of nurse practitioners at the wound care company. Project outcomes were designed and measured from pre- and post-surveys and Electronic Health Record (EHR) data retrieval. Findings/Results: Using the PUSH tool, the McNemar test on paired proportions is used to test the difference between the 1-4-week post-intervention and the 5-8-week continuation phase. The results have a difference of 65.41% with a 95% confidence interval of 58.19% to 72.64% and an extract probability of p