The Patient Advocate
One of the most important roles that a CWOCN plays is that of patient advocate. Recently my team and I were able to improve the quality of life of a patient by appropriately treating a 10-year-old vascular ulcer. The key to this success was a little pushback on the doctor that was convinced this wound would never heal. Cami, a wound care RN, was the first clinician on the scene. She started the process. She asked for a SensiLase vascular study to determine if adequate blood flow would allow for wound healing. The study was normal; she then she asked for wound cultures. Cultures came back positive for Pseudomonas, 4+ Gram Positive Bacilli, 4+ Gram-negative bacilli, 4+ Gram Positive Cocci. Next on the scene was Amy, a wound care RN. She began talking with the physician about appropriate treatment of the wound. He told her he didn’t feel it needed to be treated because it would never heal and she couldn’t possibly come to an appointment at the wound clinic because the wound was too painful. Amy’s response? “Wanna bet?” Her response surprised him and he took the challenge. If the wound heals, he will buy lunch for the wound care team. His compromise: treat the bacteria in the wound with IV antibiotics, but don’t treat the Pseudomonas for fear of causing C. difficile. Now for the wound care: Silver collagen, hydrofiber, nonadhesive foam dressings, and a two-layer compression wrap. Also in the mix was 2 days with hydroferra blue to treat the pseudomonas in the wound. And finally, the result: After 2 days of treatment the pain in the extremity was almost gone and the copious amount of foul smelling exudate was managed. Now the patient could ambulate with physical therapy and decrease the amount of pain medication she was taking. In three weeks of appropriate treatment with advanced wound care product, the wound closed. Unfortunately, the patient passed away. Ironically, as she was dying, her wound continued to heal. The pictures are the initial photos, halfway through treatment and 2 days before she passed away.