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The doctor was willing to discharge my dad back home and without any nurse support nor instructions which was shocking to me. He simply said "He is an old guy"....meaning ? Let his wounds become infected?

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Pressure sores kill. I am an RN and know how easily and quickly they do so. I am quite shocked at the advice from this doctor, and am wondering just how old a guy he is. This should be "wound care management" which is now a specialty and very precise. These are impossible to handle and become necrotic, and down to the bone. I am so sorry you had such bad advise and recommend you call and raise some "Hades" with this doctor. This is negligent treatment.
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Reply to AlvaDeer
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Superhawk, to me this is unacceptable treatment and behavior on behalf of the doctor. Was he a primary care doctor?

I would call him back and ask for a script for home care, for a nurse to assess and provide in home wound care. Start researching and contacting home care agencies to decide on one to choose, as it is your choice, not the doctor's.

If he won't do that, try to find a wound care specialist or wound care clinic. In my area, large hospitals sometimes have special wound care clinics.

To infer that he's old and not provide care is to me irresponsible. Even if he's old, wound care would make his life safer.
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Reply to GardenArtist
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Medicare will pay for a wound care nurse to visit your dad and help you learn how to treat the wounds, as well as, recommend products to alleviate the wound.

it also sounds like you need a different doctor.
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Reply to Ricky6
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I am an RN. Here are the general principles of pressure wounds:

Healthy skin needs all these components:
good oxygenation = good circulatory and good respiratory system functions
good nutrition = balanced diet and if there are wounds, a little more protein and probably vitamin pill
good hygiene = mild soap and water and mild rubbing on healthy skin to remove bacterial load
good mobility = moving self or help repositioning every 2 hours , if there are wounds, keep bodyweight off that area
good hydration = enough water so person urinates every 3-4 hours and pee is clear to straw in color

As for wound care. The adage is, "If it is dry, make it wet. If it is wet, make it dry."

Wet/Oozing wounds - clean with liquid soap like Hibiclens in water, rinse with clear water, place non-stick pads over all of wound, pad with gauze to absorb fluids, and wrap with rolled gauze or elastic bandage(ACE) and secure in place.

Dry wounds - clean with liquid soap like Hibiclens in water, rinse with clear water, allow to air dry, coat with triple antibiotic ointment, place nonstick pad over wound, wrap in rolled gauze or elastic bandage (ACE), and secure in place.

Change dressings daily and keep a record of the size, depth (use a Qtip), drainage, colors. Let doctor know if wound is getting bigger, deeper, or changing colors or drainage. Doctors can prescribe antibiotic ointments or oral medications. Doctors can also prescribe visits from a wound care specialist.

In some older folks, wounds do not heal well or easily since they usually have problems with circulation, nutrition, mobility and/or oxygenation. So, do not get discouraged if your efforts do not yield speedy results.
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Reply to Taarna
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renoir May 22, 2020
Thank you! This will be helpful for many.
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Call the physician and request that home care is ordered. Your dad needs to have the wound care provided by a registered nurse. The physician needs to write an order and if he doesn't, he needs to be reported. Saying your dad is an old guy is unacceptable. The nurse will evaluate, treat, and monitor the wound. I would tell the hospital social worker as well. The social worker is responsible for safe discharges.
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Reply to Peanuts56
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I’m confused. How does anyone know it’s unstageable without performing an assessment?
Diagnosing this would mean they’ve done some sort of evaluation.

Is it unstageable because it is not an open wound? Usually unstageable pressure ulcers are open wounds or can’t be measured for depth/width/length. Stage 1 is redness around an area With no open areas (yet). In order to be classified as unstageable the wound needs to be evaluated by a MD as they measure depth/length/width. When I was a HC RN we measured the wound weekly to assess for healing.

Did a wound specialist see the pressure ulcer while dad was in the hospital?
If it’s unstageable and no one has seen it, how could someone write woundcare orders?

Now dad will have to see a woundcare specialist to determine treatment. Then homecare will get ordered for woundcare if needed.

A physician needs to write homecare orders & specify woundcare to be completed and homecare orders the supplies designated by the doctor. Nurses can assess the wound but not write woundcare orders (unless they are PA’s or NP’s).

I can’t believe that doctor just discharged him with no instructions. Usually a nurse will come and explain discharge orders to a patient, not the doctor. Did anyone discuss this with nursing on dad’s discharge?

Change his position every two hours. Get an order for an alternating air mattress for his bed while he is sleeping.
Make sure he gets protein in him to promote tissue healing.

What does his wound look like now? As a nurse I am curious.
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Reply to Shane1124
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SuperHawk May 20, 2020
Thanks for taking the time, your concern and knowledge. Sorry if I repeat myself or fail to be more coherent I am new at forums. We are in California. Dad is still hospitalized. Just yesterday found out sacral wound is 10 to 15 cms. And there are 9 pressure areas of concern. Sacral an thigh being highest and the others just surface redness. No mention of stage. Is a wound care specialist a nurse? I was told he has been seen. I am really in the dark. I don't think he is being repositioned every 2 nor 4 hours. They do check dressings in two different shifts I think.
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Are you and your dad in the US?

Discharged from a US hospital? Call the patient advocate tomorrow and report this.


AFTER you get the doc to prescribe home care services, of course.
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Reply to BarbBrooklyn
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SuperHawk May 20, 2020
I am being careful not to be incendiary before getting help for My father. I was able to suspend his discharge. We are in California. The other disturbing fact is that any moment doctor can call for same day discharge. So no time to look for alternatives ....they do this on purpose. To catch the vulnerable caregiver by surprise.
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A pressure sore needs to medically monitored and treated. If your dad has been hospitalized long .enough to qualify for home health follow up visits, set those up right away. Learn all you can from nurses and online about how to care for wounds yourself for when you are left on your own. You can do it, but you need to know what to do.
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Reply to RedVanAnnie
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Superhawk, thanks for the additional explanations.

You wrote the magic words: HMO, rotating doctors assigned by the HMO.

It might be costly to get Medicare now, but please do consider it.

And even though the HMO assigns the doctors, you still have a right to criticize, or call an Ombudsperson. And I would do that.
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Reply to GardenArtist
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SuperHawk May 21, 2020
Hello GardenArtist. Right now any change would be impossible. I would need to change medical group. The HMO works with several medical groups and they are the ones handling the medical portion alongside medicare. I hope dad survives all this medical incompetence.
I am looking into getting an ombdusperson if they try to discharge him to an unsafe skilled nursing facility without consulting me. I hope the SNF know better and tell them not until his sacral sore is not addressed medically. I do not think dad is getting antibiotic therapy to avoid sepsis. They are with the wait and see approach. Very mean system.
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I would definitely get some home health care. This doctor sounds like he should not be working in his field. I treated my mom's stage 4 wound which she got during rehab in a Medicare 5 star rated nursing home, and I didn't find out about the wound until she was hospitalized from there and the hospital intake nurse told me about it. I took her home never to return to that NH. A wound nurse at the hospital did train me to clean and bandage the wound. I used a coloidal silver spray on the dressing, and upped my mom's protein intake for healing,(not too much as too much protein is bad for the kidneys. Gave her peanut butter toast for breakfast daily. The wound began to shrink. She also saw a wound doctor every week or couple of weeks, and they were helpful with instructions. I wish you all the best, and keep after those hospital social workers, etc. to help you.
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