Re: Medicare is Killing My Friend

This is an update on my friend, Rich. He will be discharged to home by Thursday or Friday still having a bone infection(osteomyelitis), two drainage tubes, and a deep sacral decubitius. Welcome to the new health care reform and apparently the new standard of care.

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• Cuts
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• Friend
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• health
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• Mia0899cs

[jazzdanca59]

I had osteomylitis of the sacrum 30 yrs ago. It took ages in the run around of the specialists to finally know what the swelling and heat was over the area. It was an othopaedic surgeon who recognised it straight away. It took nearly a year to fight the infection with flucloxacillin, and rest rest rest. I was in the airforce at the time and the useless medical staff there wanted to pack the wound which the surgeon had told me THEY MUST NOT DO. I had surgery to clean out the wound 3 times.

[mia0899cs]

@jazzdanca59 Rich had the run around too and they insisted on the wound vac which didn't help and I believe he was becoming anemic from that. It even states don't use if there is an active infection, osteomyelitis. So, when he finally met with the right orthopaedic surgeon and plastic surgeon(Same Dr. performed both operations Dr. Levine) he saved his leg, cleaned out the pelvic area and femur and performed a skin graft. He said he had so much scar tissue from these other Dr.'s messing around.

[calligraphy131]

If you stand there and observe it will be helpful. If there is drainage overflowing out of the dressing then just call them and and let them know, esp. if it is green or foul smelling. Be sure they are not forcibly putting in the packing, the key is that it must be loose so as not to compress the wound bed and maybe they are irrigating with antibiotic solution? Too many changes are not good either, but once a day seems realistic

[mia0899cs]

4x4 folded in half. Then an abdominal pad covered with tegaderm. The one nurse can't use the tegaderm and he does his own dressing the way he wants. It's not that hard if he would look at the example on the box. However, Rich won't complain. Another area of interest is this recommendation to get a colostomy before surgery is done. He hadan abcess create the decub from osteomyelitis and there's no guarantee that this infection will be gone because it hides. What is your opinion on colostomy?

[mia0899cs]

I've done this kind of work for yrs as an RN, BSN. They only say, "Looks smaller." I don't think they know how to measure correctly either like at 1 o'clock and so forth. I use the saline wash they have and get right in there until a clean return and with the sterile q-tip. Then I take another sterile q-tip and pack with this. It uses the entire package,however, the one nurse doesn't use all of it and saves the rest. I was outraged. Once that is open, it has to be thrown out. Then a 4x4.

[mia0899cs]

I did look to see what is ordered for his dressing change. There's silver in it, which is great. I forget the exact name. It probably is an alginate. I change the dressing sometimes, because he is only getting a nurse to change it every other day even though the orders say 1-3 daily as needed. He can't change it himself and I told the one visiting nurse this last wk. I can do a great dressing change, but my back kills me and I"m disabled because of it. I could teach them, but they get mad.

[calligraphy131]

yes vancomycin resistant. use light packing, if too much drainage use calcium alginate and pack lightly. Cover with the sterile 4x4. Clean gently with sterile NSS prior to dressing change. Has to heal from inside out. The visiting nurse can refer back to MD and request he needs more care in skilled subacute unit. use the sterile 4x4, slightly moist only and very loosely packed. Carefully remove old dressing, soak with saline if it sticks. Then absorb extra moisture with sterile 4x4.

[mia0899cs]

Is that VRSA, Vanco Resistant? The vanco only kept the infection stable. They discharged him with Bactrim DS. So, this will help with any urinary infections. U. of Penn didn't admit him. He goes back on 10/21. I don't know the name of what it is packed with. I did it last week and there is granulation, no tunneling, no odor, and it is getting smaller. The visiting nurse and social worker feel he should be in the hospital. However, they said he only has 21 days of Medicare left, so that's why.

[calligraphy131]

Yes that will be the best thing for him, I really hope he gets better. They have many treatments for recalcitrant wounds like using silver and even honey from New Zealand. Wet to dry is a never. It sounds like he needs more iv antibiotics. The coding also covers the days of care, so the doctor has to be sure to code properly. the nursing documentation of the description of the wound is critical. MRSA easily gets into the urine too. If he gets diarrhea he can get clostridium difficile also.

[mia0899cs]

He is actually seeing a wound care specialist today. This is the first time since he has been discharged. He has MRSA and Osteomyelitis. Tomorrow, we go to the University of Penn to see an Orthopedic Specialist so we both are praying that the doctor will admit him.