Wound Care: A Review of Open Access and Enclara Client Resources

Wound care questions related to dressings and topical products are commonly asked of hospice and palliative care pharmacists. Although few pharmacists are trained specifically in wound care, pharmacists are resourceful and able to identify where to direct clinicians for answers. We are using this opportunity to showcase a few resources that may be useful for fact finding and for training your hospice staff.


Palliative wound care focuses on relieving suffering and improving the patient’s quality of life when the wound no longer responds to, or the patient can no longer tolerate, curative treatment.1 Typical wound treatment primarily focuses on bringing a wound to closure, however palliative care focuses on symptom management.1 Symptoms addressed include pain, infection, wound odor, exudate, bleeding, and decreased quality of life.1,2

In palliative wound care, it is recommended that therapy selection be based on the wound presentation: Select products that can stay in place for more than a day, manage bioburden, control odor, and help with both chronic pain and incidental pain associated with the application and removal of dressings.3


Pain control is integral for palliative wound care. Pain impacts quality of life and must always be treated, preferably systemically with an opioid-based agent or topically, where feasible and effective.1

Quick Reference Resources

  • Enclara Pharmacia Palliative Pearls: Topical Analgesics for Local Pain. 2019 Aug. Click here
  • Steele K. Topical Treatments for Acute and Chronic Wound Pain. PCNOW Fast Facts #327. 2016 Dec. Click here
  • Enclara Pharmacia Clients: Download Topical Morphine PLO & Intrasite Gels: Quick Facts in client portal


  • Serena T, Yaakov R, Aslam S, Aslam R. Preventing, Minimizing, and Managing Pain in Patients with Chronic Wounds: Challenges and Solutions. Chr Wound Care Manage Res 2016:3 85–90. Click here
  • Faria C, Branco V, Ferreira P, et al. Total Pain Management and a Malignant Wound: The Importance of Early Palliative Care Referral. 2021 Dec;13(12):e20678. Click here
  • Schneider C, Stratman S, Federman D, Lev-Tov H. Dealing with Pain: An Approach to Chronic Pain Management in Wound Patients. Today’s Wound Clinic. 2020 Nov. Click here


Infection of a chronic wound produces an enhanced and prolonged inflammatory response, which in turn causes more damage to the wound.1 Consequently, symptoms that would normally indicate the presence of an infection would be masked as the prolonged inflammatory response also reduces the patient’s immune response.1

Quick Reference Sites

  • WoundSource: Debridement. Click here
  • WoundSource: Antimicrobial Dressings. Click here
  • Enclara Pharmacia Clients: Download Wound Care Medications in Hospice: Debridement in client portal


  • Wound Source Editors. Managing Wound Infection: Opportunities in Antimicrobial Stewardship. WoundSource.com. 2020 Jan. Click here
  • Worster B, Zawora MQ, Hsieh C. Common Questions About Wound Care. Am Fam Physician. 2015;91(2):86-92. Click here


Malodorous wounds can negatively impact the patient’s relationship with family and friends, contributing to social isolation. Wound odor is usually produced by bacteria present in the wound.1 Limiting the bacterial burden on the wound, managing exudate, wound cleansing, and the application of odor controlling dressings, such as those containing charcoal or carbon, can all help to reduce wound odor.1

Quick Reference Sites

  • Enclara Pharmacia Palliative Pearls: Wound Odor Management. 2017 Jul. Click here
  • Patel B, Cox-Hayley D. Managing Wound Odor. PCNOW Fast Facts #218. 2015 Aug. Click here


  • Akhmetova A, Saliev T, Allan IU, et al. A Comprehensive Review of Topical Odor-Controlling Treatment Options for Chronic Wounds. J Wound Ostomy Continence Nurs. 2016 Nov; 43(6): 598–609. Click here


Exudate presents a particular challenge in wound care. Proteinaises (tissue-destroying enzymes) present in wound exudate damage periwound skin and can enlarge the wound.1

Quick Reference Sites

  • WoundSource.com: Specialty Absorptives/Super Absorbents [Dressings] – Click here


  • Hovan H. Wound Exudate: What Does This Color Mean for My Patient? WoundSource.com. 2021 Mar. Click here
  • WoundSource Editors. Identifying the Different Types of Wound Drainage. WoundSource.com. 2021 Apr. Click here


Minor topical bleeding is relatively common in the hospice population, whether the result of a bleeding malignant wound, coagulation issues or secondary to disease progression. The best way to control a bleed is to prevent it from happening by using non-adherent dressings or minimizing patient risk. Inevitably, however, minor topical bleeding, refractory to dressings and applied pressure, will occur and require medication therapy.

Quick References:

  • Enclara Pharmacia Palliative Pearls: Managing Bleeding Fungating Wounds/Tumors. 2016 Oct. Click here
  • WoundSource.com: Contact Layers [Dressings] – Click here
  • Enclara Clients: Download Oxymetolazine for Minor Topical Bleeding: Quick Facts in client portal.


  • Yorkshire Palliative Medicine Clinical Guidelines Group: Guidelines on the management of bleeding for palliative care patients with cancer – Summary. 2009 Jan. Click here
  • Recka K, Montagnini M, Vitale CA. Management of bleeding associated with malignant wounds. J Palliat Med. 2012; 15(8):952-954. Click here


Quick References:

  • WoundSource.com – Main Site – Click here
  • WoundEducators.com – Main Site – Click here
  • WoundSource.com. Dressings. Click here
  • WoundEducators.com. Wound Dressings. Click here
  • Carver C. How Do You Select a Wound Dressing? WoundSource.com. 2021 Mar. Click here
  • Ferris F, von Gunten CF. Malignant Wounds. PCNOW Fast Facts #46. 2015 May. Click here


  • Sibbald RG. Wound Bed Preparation 2021. Adv Skin Wound Care. 2021 Apr; 34(4): 183–195. Published online 2021 Mar 22. Click here
  • Vardhan M, Flaminio Z, Sapru S, et al. The Microbiome, Malignant Fungating Wounds, and Palliative Care. Front Cell Infect Microbiol. 2019; 9:373. Click here
  • Graves ML, Sun V. Providing Quality Wound Care at the End of Life. J Hosp Palliat Nurs. 2013 Apr;15(2): 66-74. Click here
  • Woo KY, et al. Local wound care for malignant and palliative wounds. Adv Skin Wound Care. Sept 2010;23:417-28. Click here


Hospice and palliative care pharmacists utilize several online resources to direct the interdisciplinary team to appropriate wound care therapies and products (e.g., dressings). Most wound care products are procured from medical supply resources, such as Medline and Cardinal. However, not all pharmacies routinely stock wound care products. It’s important to be familiar with the wound care supply availability at your regular pharmacy and identify an alternate source for wound care needs, commonly the supplier of your other medical supply needs.


Download a copy of this month’s case study to share with your colleagues or to keep for personal reference.


  1. Krasner D. Palliative Wound Care. WoundSource.com. 2019. Click here
  2. Woo KY, Krasner DL, Kennedy B, et al. Palliative Wound Care Management Strategies for Palliative Patients and Their Circles of Care. Adv Skin Wound Care. 2015;29(3):130-140. Click here
  3. Hovan H. Palliative vs. Curative Wound Care. WoundSource.com. 2018 Apr. Click here