Kennedy Terminal Ulcers: A Palliative Care Unit's Experience over a 12 Month Period of Time - Alzheimer's and Pressure Sores (Bedsores)

Problem: The phenomenon of Kennedy Terminal Ulcers is not well understood. The term
describes skin changes occurring in patients just prior to the end of life. Staff observing skin
changes on our Palliative Care unit documented it as deep tissue injuries and were concerned
that their rigorous efforts in prevention may have been insufficient to prevent skin
breakdown. After a comprehensive literature search, we realized we were noting a
phenomenon that indicated impending death.

Evidence: Skin changes described above were noted and presented by Karen L. Kennedy
and labeled after her. After reading the Consensus Statement on SCALE (Skin Changes at
Life's End 2009), and conducting a literature review, a database of patients with suspected
Kennedy lesions was created to identify trends in this unit.

Strategy: Data was collected on all suspected Kennedy Ulcers to track and trend skin
changes, validate our hypothesis regarding these skin changes at life's end, and provide a
basis for ongoing education and practice change.

Practice Change: As a correlation between identification of skin lesion and time of death
emerged, we were better able to provide family members with timely information regarding
prognosis.

Evaluation: As we evaluated our database, we were able to identify that the development of
Kennedy Ulcers did not indicate a practice failure.

Results: Our database demonstrated a distinct correlation between development of lesion and
time of death. Time frame for the development of the lesion ranged from 2 to 25 hours prior
to death.

Recommendations: Further study and dissemination is needed along with guidelines to
facilitate practice changes. We will be conducting a descriptive study. Our observations have
been accepted for publication in 4/09 in the Journal of World Council of Enterostomal
Therapists.

Lessons Learned: As a team leader, I have learned to always be open to new possibilities
and unique scenarios, and to mentor my staff in a non-punitive and supportive environment.
Inclusion of all staff members in this initiative has augmented its success.

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Kathy A. Trombley, Mary Brennan