CASE 78 Unapproved Treatments:Honey on the Wound

Dale Buchbinder

Dr. Keene was making rounds at Old Town Nursing Home (OTNH). The Director of Nursing asked Dr. Keene to see Mr. Leroy, a new patient. Members of the nursing staff were concerned and quite agitated over an unusual family demand. She needed his expert opinion.

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Mr. Leroy, an 80-year-old white male, had several strokes and was not able to make decisions for himself. He arrived at OTNH with a large open wound on his left foot. After Mr. Leroy’s arrival, the patient’s son insisted that the nursing staff should place sterile honey and maggots on the wound. Mr. Leroy’s son, a veterinarian, felt this was a good treatment for cleaning up his father’s extremely necrotic and odorous wound. The nursing staff questioned this mode of treatment and also expressed concern that nothing had been done for the patient while he was at home. In fact, the wound had not been attended to at all. Why was the veterinarian just now insisting on this unapproved therapy?

Dr. Keene called Mr. Leroy’s son and the two of them had an extensive discussion about the pros and cons of using honey and maggots on a human wound in a nursing home facility. Dr. Keene informed the son that since this was not an approved treatment, the nursing home could not administer it. Furthermore, Mr. Leroy needed a circulation check to assess whether he had adequate circulation to heal his wound, as well as a thorough medical evaluation for comorbidities, i.e., underlying medical conditions, which needed to be addressed.

Unsatisfied with Dr. Keene’s responses, the patient’s son called the Nursing Home Administrator. The veterinarian again insisted the nursing staff should administer the honey and maggot treatment. After a lengthy discussion with the Nursing Home Administrator, Dr. Keene refused to allow the unapproved treatment. That day, Mr. Leroy’s son signed the patient out of the nursing home without allowing any circulatory or medical assessments. He told the staff he was taking his father home so he could perform the honey and maggot treatment.

 

Case Study Evaluation
Prepare a written report of the case using the following format:
Background Statement: What is going on in this case as it relates to the identified major problem?
What are (only) the key points a reader needs to know in order to understand how you will “solve” the case?
Summarize the scenario in your own words—do not simply regurgitate the case. Briefly describe the organization, setting, situation, who is involved, who decides what, etc. Specifically identify the major problems and secondary issues.
What are the real issues? What are the differences? Can secondary issues become major problems?
Present an analysis of the causes and effects.
Fully explain your reasoning. Declare your role in a sentence or a short paragraph explaining from what role you will address the major problem and whether you are the chief administrator in the case or an outside consultant called in to advise.
Regardless of your choice, you must justify in writing as to why you chose that role. What are the advantages and disadvantages of your selected role? Be specific.
Recognize the strengths and weaknesses of the organization.
Identify the strengths and weaknesses that exist in relation to the major problem. Again, your focus here should be in describing what the organization is capable of doing (and not capable of doing) with respect to addressing the major problem. Thus, the identified strengths and weaknesses should include those at the managerial level of the problem. For example, if you have chosen to address the problem from the departmental perspective and the department is understaffed, that is a weakness worthy of mentioning. Be sure to remember to include any strengths/weaknesses that may be related to diversity issues.
Find out alternatives and recommend a solution.
Describe the two to three alternative solutions you came up with. What feasible strategies would you recommend? What are the pros and cons? State what should be done—why, how, and by whom. Be specific. Evaluate how you would know when you’ve gotten there. There must be measurable goals put in place with the recommendations. Money is easiest to measure; what else can be measured? What evaluation plan would you put in place to assess whether you are reaching your goals?
TIP: Write this section as if you are trying to “sell” your proposed solution to the organization. Convince the reader that your proposed solution is the best available and that it will work as planned. Make sure that the goals you identify are worth the effort required to achieve them!

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