Hospice symptom management
Hospice wound and skin care
Hospice wound care reframes the goal from healing to comfort, dignity, and odor control. Some wounds late in life — including the Kennedy Terminal Ulcer — are markers of the dying process and will not heal regardless of intervention. Understanding this reframing is central to hospice wound work.
Educational content only. Individual clinicians must confirm current dosing and drug availability against their hospice medical director and current formulary. This is not a substitute for your hospice’s policies or your medical director’s clinical judgment.
Quick framework
- Assess: type, size, depth, drainage, odor, pain, tissue viability.
- Set a palliative goal: comfort, odor control, drainage management, dignity. Healing is a secondary aspiration.
- Turn and reposition every 2 hours (as tolerated) for pressure prevention; consider air mattress.
- Manage exudate with appropriate dressing type and frequency to minimize dressing-change discomfort.
- Control odor: metronidazole 250 mg PO or crushed and applied topically; charcoal dressings; frequent linen changes.
Pharmacology
- 01Metronidazole 250–500 mg PO BID or topical (crushed + applied under a foam dressing) for malodorous fungating wounds.
- 02Lidocaine 2% gel applied 10–15 min before dressing changes for painful wounds.
- 03Systemic opioids scheduled at 20–30 minutes before painful dressing changes.
- 04Silver-impregnated or honey-based dressings for bioburden control.
- 05Antifungal creams for candidal skin folds.
Non-pharmacological approaches
- Repositioning schedule with visual chart at the bedside.
- Air mattress for bedbound patients.
- Heel protectors, elbow protectors.
- Barrier creams (zinc oxide, dimethicone) on at-risk skin.
- Frequent linen changes; consider chlorophyllin capsules or open pans of coffee grounds at the bedside for odor control.
- Aromatherapy (patient-approved scent) to shift the ambient sensory experience.
When to escalate
- New wound with rapid extension or unclear etiology.
- Fever + wound (potential source of infection): treat if aligned with goals of care.
- Bleeding requiring hemostatic dressings or oral tranexamic acid.
- Family emotional distress at the wound presence — schedule a bereavement or pastoral visit to normalize and support.
Documentation example
A composite narrative illustrating a defensible chart entry (identifying details fictionalized):
Patient with a stage 4 sacral pressure injury measuring 8×6×3 cm with copious foul-smelling exudate. Started metronidazole 500 mg PO BID + silver alginate dressing changed q48h with premedication of morphine 15 mg PO 30 min prior. Repositioning schedule posted at bedside. Family educated that healing is not the goal; comfort and dignity are. Reassess wound at each dressing change; expect stabilization of odor within 3–5 days on metronidazole.
FAQ
What is a Kennedy Terminal Ulcer?
Should we always try to heal wounds in hospice?
What about ordering wound VAC?
Grow every hospice competency, one symptom at a time.
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Educational content only. Not a substitute for your organization’s policies, your medical director’s clinical judgment, or current hospice formulary.