PP054 OPTIMISING THE OUTCOMES OF MANAGING COMPLEX PRESSURE INJURIES IN INPATIENT PALLIATIVE CARE SETTING IN SINAGPORE: A CASE STUDY.

Aim: Complex pressure injuries (PI) are a significant worldwide issue for the healthcare system and are prevalent in advanced illness populations. This paper aims to share the holistic management of complex PI in advanced dementia patient to achieve the best outcomes. Method: Mdm T, a 67 years lady with advanced dementia was admitted from a nursing home. She had diabetes mellitus, bullous pemphigoid and multiple pressure injuries. On admission, Mdm T's stage 4 sacral PI measured at 22x14x2cm, undermining 10-1 o'clock 2 cm, bone, ligaments visible with 60% full-thickness necrotic tissue, malodour, and heavy hemopurulent discharge. Scattered of skin erosion over periwound skin. Patient was tachycardia and febrile since one week ago. The goals of wound care manage ongoing infection, malodor, and excessive exudation. Wound bed preparation (TIME concepts) was adopted in wound management after comprehensive wound assessment. The approach of regular wound cleansing with the antimicrobial solution, autolytic debridement, and periodically conservative sharp wound debridement to remove bioburden and non-viable tissue--subsequently, Negative Pressure Wound Therapy initiated for short term to promote cell proliferation and enhance sacral wound contractions. Ciprofloxacin was started after two days on top of Augmentin to treat Pseudomonas infection. Results / Discussion: After 16 days, Mdm T's sacral wound shown vast improvement with 90% of pinkish granulation tissue, nil odour and with wound infection resolved. Mdm T's son feedback that patient shown subjective improvement to be able to interact with him by maintaining eye contact on his visits. Conclusion: It is indeed challenging to manage patient with multiple complex pressure injuries. This case demonstrated with access to specialized wound care nurse in inpatient palliative setting, it helps to improve the wound outcome and QoL for patients. Most importantly, it enhances overall nursing practices on wound management. [ABSTRACT FROM AUTHOR]