Thank you for your question, Nora! Sounds like a difficult social situation. Can the patient not be ordered to be home bound by a provider and then home health ordered? That doesn't always work for us but it has in a pinch. Is the patient able to be transferred to a SNF or a swing bed at a critical access facility for a short stay in attempt to get some healing and BG control? Otherwise sounds like he will be at high risk for being readmitted. Without skilled assistance placing a vac, I fear you are correct that it may not be a fruitful endeavor. With wounds in proximity to the rectum, antimicrobial dressings changed frequently are usually the most feasible. Could the surgeon's office not see him at least biweekly for assistance with dressing changes and assessment? I know they often don't desire this due to reimbursement/global but may be necessary unless this gent wants to live in the hospital.

Thank you for your question, Nora! Sounds like a difficult social situation. Can the patient not be ordered to be home bound by a provider and then home health ordered? That doesn't always work for us but it has in a pinch. Is the patient able to be transferred to a SNF or a swing bed at a critical access facility for a short stay in attempt to get some healing and BG control? Otherwise sounds like he will be at high risk for being readmitted. Without skilled assistance placing a vac, I fear you are correct that it may not be a fruitful endeavor. With wounds in proximity to the rectum, antimicrobial dressings changed frequently are usually the most feasible. Could the surgeon's office not see him at least biweekly for assistance with dressing changes and assessment? I know they often don't desire this due to reimbursement/global but may be necessary unless this gent wants to live in the hospital.

Hi, thanks for the response. The outpatient surgical office has unfortunately been unable to commit to helping with wound care recently but we may need to explore this, along with possible SNF. As for dressing options, are there any in particular you would recommend, other than wet to dry packing with Vashe or NPWT? The trouble is, anything that's used, will likely go through a high volume of product due to frequency of dressing changes. For instance gentian violet & methylene blue antibacterial foam. Or even using prisma collagen 1x/day? Is vashe enough if stool does get into the wound bed or should Dakin's be considered?

I was referring to the surgeon that performed the debridement, they should be in the care team and at least be able to evaluate the patient at some interval in my opinion. I understand the dynamic may be tough as they don't desire to take on anything that doesn't involve additional revenue. My suggestion for large volume of product would be to order kerlex/abd or burn dressing gauze from a DME provider along with a specialty absorptive like sorbion or equivalent. There is a way to write orders using the different categories of dressings to your advantage as you can order a primary like aquacel, a secondary line mepilex foam or other non bordered foam and a tertiary like specialty absorptive (sorbion sachet, drawtex, etc), and then cover with kerlex or burn dressing gauze sheet/ABD and have patient purchase mesh panties or other loose but secure shorts to go over dressing that can be laundered. Does this make sense? They will be shipped to patient's home and they can perform dressings, ordered daily is the most frequent that will usually be reimbursed for patient. I truly think SNF or swing bed at CAH will be most beneficial for this patient as it will be more conducive to BG control and monitored wound care.

I was referring to the surgeon that performed the debridement, they should be in the care team and at least be able to evaluate the patient at some interval in my opinion. I understand the dynamic may be tough as they don't desire to take on anything that doesn't involve additional revenue. My suggestion for large volume of product would be to order kerlex/abd or burn dressing gauze from a DME provider along with a specialty absorptive like sorbion or equivalent. There is a way to write orders using the different categories of dressings to your advantage as you can order a primary like aquacel, a secondary line mepilex foam or other non bordered foam and a tertiary like specialty absorptive (sorbion sachet, drawtex, etc), and then cover with kerlex or burn dressing gauze sheet/ABD and have patient purchase mesh panties or other loose but secure shorts to go over dressing that can be laundered. Does this make sense? They will be shipped to patient's home and they can perform dressings, ordered daily is the most frequent that will usually be reimbursed for patient. I truly think SNF or swing bed at CAH will be most beneficial for this patient as it will be more conducive to BG control and monitored wound care.