Kennedy Terminal Ulcer

Heidi Cross's picture
Risk Factors for Unavoidable Ulcers

by Heidi H. Cross, MSN, RN, FNP-BC, CWON

According to the Agency for Healthcare Research and Quality, more than 17,000 lawsuits related to pressure ulcers (PUs) are filed annually in the United States, second only to wrongful death lawsuits. One of the greatest gifts to defense attorneys was when the Centers for Medicare & Medicaid Services (CMS) published F-Tag 314, finally acknowledging that some ulcers can occur despite best care. The facility essentially can maintain, “Hey, we did everything we were supposed to, and despite that, the patient developed that pressure ulcer”—that is, the ulcer was unavoidable. To prove unavoidability, proper documentation (proof) of best care needs to be in place, as well as documentation that all proper prevention and treatment measures were implemented.

WoundSource Practice Accelerator's picture
Palliative Care

by the WoundSource Editors

Pressure Injury/Ulcer Risk Management in Palliative Care and Hospice

Palliative care and hospice care are not the same, but they both share one goal. They both focus on a patient's physical, mental, social, and spiritual needs. Palliative care can begin at diagnosis and treatment or for patients at any stage of their illness. Patients may not want to receive aggressive treatment of non-healing wounds because of underlying diseases, pain, and/or cost.1

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Jeffrey M. Levine's picture

By Jeffrey Levine MD

Please join me Thursday, November 16 from 3:00-4:00pm EST for a free webinar presented by myself and Elizabeth A. Ayello, PhD, RN, ACNS-BC, CWOCN, ETN, MAPWCA, FAAN sponsored by the National Pressure Ulcer Advisory Panel (NPUAP), entitled, Unavoidable Pressure Injuries, Terminal Ulceration, and Skin Failure: Where Are We and Where Are We Going?

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Jeffrey M. Levine's picture
medical community discussion

By Jeffrey M. Levine MD, AGSF, CWS-P

As Co-Chair of the NPUAP Education Committee it is my pleasure to invite all clinicians to the NPUAP Biennial Conference in New Orleans from March 10 to 11, 2017. Featured topics will include best practices for staging and treatment, pressure injury recidivism, and pressure injury as a quality measure. In addition to these timely topics, NPUAP will host a full day featuring national experts who will discuss terminal ulceration, skin failure, and unavoidable pressure injury. Attendees are invited to submit cases that illustrate these lesions, and a select number of submissions will be presented for discussion with the group.

Rick Hall's picture
documenting wounds

By Rick Hall, BA, RN, CWON

Wound care documentation is a hot topic with overseeing agencies dealing with the medical industry. Good documentation is imperative to protect all those giving care to patients. Documentation should be Legible, Accurate, Whole, Substantiated, Unaltered, Intelligible and Timely. If these components are not incorporated into your wound care documentation, you could end up in a LAWSUIT.

Aletha Tippett MD's picture

By Aletha Tippett MD

I recently had a patient encounter that reminded me of the difference between palliative and curative wound care. In my role as a hospice medical director with a specialty in wound care, I am often asked to see wounds in our hospice patients. I was asked to see this particular patient because of a wound on her coccyx. I had already approved the nurse’s order of medicated hydrogel covered with a foam dressing, changed every three days. This seemed like a reasonable treatment plan; simple and straightforward. I also gave instructions to provide adequate support surface on her mattress, static air if possible.

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Lindsay Andronaco's picture

By Lindsay D. Andronaco RN, BSN, CWCN, WOC, DAPWCA, FAACWS

In the past two blogs I have discussed a controversial topic, skin failure. We all have strong feelings on this topic and have experienced different cases in our practice. Dispute the controversial feelings on KTUs and skin failure; I would like to now just address the viewpoint of the family and how to approach these difficult conversations.

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Lindsay Andronaco's picture

By Lindsay D. Andronaco RN, BSN, CWCN, WOC, DAPWCA, FAACWS

Part 2 in a series on skin failure
For Part 1, Click Here

In March of 1989 the National Pressure Ulcer Advisory Panel (NPUAP) convened, during which Karen Lou Kennedy first described the Kennedy Terminal Ulcer (KTU) phenomenon. A KTU is an unavoidable skin breakdown or skin failure that is thought to be a perfusion problem exacerbated by vascular/profusion insufficiency, organ failure, and/or the dying process. A KTU is a visible sign, an explanation, of what is transpiring within the patient.

Lindsay Andronaco's picture

By Lindsay D. Andronaco RN, BSN, CWCN, WOC, DAPWCA, FAACWS

Part 1 in a series on skin failure

A few years ago, a panel of experts gathered to evaluate the nature of skin changes at life's end (SCALE) and to discuss the Kennedy Terminal Ulcer (KTU). The panel concluded that there are observable changes in the skin at the end of life and that these situations are complex. It should be noted that the skin is an organ and it can fail. The skin can also demonstrate what is happening internally, such as multisystem organ failure.