Wound care at Acorns hospice

About Acorns

Acorns Children’s Hospice in the Black Country provides care and support for children with life limiting or life threatening illnesses and their families.

The ages of the children are from birth up to 18 years. Acorns Hospices provide palliative and end of life care, and short breaks for families in the hospice and at home. Ensuring that all our clients care is delivered to a high standard is a must for all who work at Acorns.

The children we care for often cannot move themselves, cannot eat without help or are in so much pain that the slightest of movements is difficult. These are common risk factors for pressure ulcer development and wound management, so can be a challenge.

I have been asked why wound care and tissue viability is important in children at end of life; the answer to that is a simple one - why make their suffering worse with untreated wounds or pressure ulcers that cause unnecessary pain and discomfort? 

...Taking simple things into consideration can make all the difference when caring for the children. 

The process of healing

Finding the right balance with the treatment and care they need is a must in such an environment.

The physiological course of healing in paediatric wounds is similar to that seen in adults, excepting that children’s wounds often heal faster. However in children with a life limited/life threatened condition, factors are present which may slow down the healing process. Conditions such as muscular dystrophy,  chromosome abnormalities or enzyme imbalance will change how the skin behaves in certain situations.

Understanding the process of normal wound healing is needed to compare and understand that of wound healing with children who have conditions that will affect it. The phases of haemostasis, inflammation, granulation and maturation all have to be considered carefully to understand and learn the changes in these processes for the child.

Assessment

At Acorns we aim to assess pressure ulcer (PU) risk within 24 hours of admission, and note any existing wounds, marks or pressure ulcers. The tissue viability team then review the assessments and develop a PU prevention plan or wound management plan, referring to other health care professionals where necessary and appropriate.

Eliminating potential causes of pressure ulcers is important of course. We use a variety of devices such as oxygen saturation probes, naso-gastric tubes, gastrostomy tubes, plaster casts, and wheelchairs, which can facilitate PU development. If it is clinically necessary to continue to use these, we seek ways of relieving pressure, for example, using a dressing to prevent shear and friction, regular turning and pressure relieving-equipment. The whole multidisciplinary team is involved, and includes the physiotherapist, general practitioners, community nurses, school nurses and the family. This approach allows high standard of knowledge based care to be provided.

The assessment is discussed with family and other professionals throughout to maintain good communication.  Documentation ensures a high standard of care and that any multi-disciplinary team member can be contacted and clearly identify what has already been done and what needs to be done further.

The anxious child

Children have a heightened set of emotions, especially when in a different setting from home. If they have undergone previous treatments and had a bad experience, we need to take this into consideration; there are methods of reducing anxiety such as play therapy or distraction techniques.

But also we can use extra care in removing dressings and explain all to the child and family at all times. It is no excuse to say that the child does not understand; this cannot be proven and we should accept that they still feel pain and discomfort and may be scared.

Reassure them, guide them; let them guide you in the care provided ensuring that it is within best practice guidelines.

Pain/discomfort

In the hospice setting we have many ways in which we treat pain. Oral medication, medication via gastrostomy, sub cutaneous medication, patches and syringe drivers. When treating a child we assess their pain, and if appropriate and required, will give them analgesia.

We can use a mixture of dressings to best suit the child, adapting as we go along. The tissue viability team within the setting will communicate and discuss any treatment they may feel is required with general practitioners for the children. They aim to lessen emotional distress and promote dignity, comfort and wellbeing.

Conclusion

Every child deserves the best care whether at end of life or just a routine hospital visit. At Acorns, giving of our best, particularly in wound care, is something we all aim for.