To some of us who have been nursing a chronic pressure wound for a long time and not seeing much progress, we wonder- why is the wound healing not progressing in the way we would expect it to?
We know the rules to preventing pressure injury and promoting wound healing. Yet an encounter recently showed me what a change in bed can help in making the difference. A quicker definition to a hospital bed is one with adjustable head elevation, lower limbs elevation and full bed height. Hospital beds are the bed patients used mostly in hospitals which is why its name and it facilitates nursing a lot.
So I was asked to see a patient who has a chronic sacral wound for the last 9 months. She has been in and out of the hospital but mostly cared by her family and a foreign domestic caregiver.
Her wound has been assessed by the hospital team and a wound specialist home nurse. The patient, Mdm Chan (not her real name) is an 86 years old lady who is highly dependent on her care delivery. She used to have a palm size wound that have been much reduced to 4cm x 2.5cm. Her team did a good job in nursing her wound. However it was after 6 months that the wound healing became almost stagnant. It started to tunnel which means there is a detachment between the skin and the flesh resulting in a hole that runs beyond the exposed wound. When I saw her, I was told that Mdm Chan tends to fidgets and switches position from the side to supine (lying on her back). No matter how her caregiver stuff pillows to support her, she would return to supine position. As the rule of nursing applies, a person should not be in a fixed position for more than 2 hours.
The implication of poor position and fidgeting are:
1. The development of skin tears and sores by constant pressure on the skin.
2. The development of tunnels inside the wound
3. Poor adhesion of wound care products
Apart from the problems it may cause to Mdm Chan, the result of daily wound care also means more care from her caregiver and the financial implication of that regular wound care.
After treating her for about 3 weeks with a change from silver dressings to calcium alginate dressing, with less exudate but no change in size of the wound, I suggested to her daughter to consider a hospital bed as that could help in head elevation and to maintain certain positions. Her daughter was keen to explore and with some help, she found a second hand electrical adjustable bed and Mdm Chan started using it.
Within the first day of use, her caregiver noticed that Mdm Chan was able to maintain her reposition better and longer. Her wound dressings lasted for 2 days now.
After about 2.5 weeks, her wound size shrunk from 4cm in length to 3.5cm. The tunnel that was 3cm deep , is now 2 cm deep. In the meantime, there were no new medication or change in dressing materials. The bed was the only switch we made.
What an amazing result in 2.5 weeks! And you bet, caregivers were very much happier.