Short answer is there’s not much we can do if the patient does not take responsibly by sticking to the treatment plan. Effective treatment plans must be taylor made for each patient to ensure the plan is realistic. This is where good documentation is key! Documentation should always include your education of the patient about the possible outcomes (loss of limb and maybe even life), your patient's reactions to that education, the reasons for non-adherence, and what other possible alternative treatments may have been offered. I am sure you have checked out the patient's HbA1c to try to correct any chronic hyperglycemia, as well as circulation for any possible interventions to correct ischemic issues. Barring all that, it may be time to take a more palliative approach to this wound, explain it to your patient, and maintain the eschar with dry dressings to keep it dry and stable.
Short answer is there’s not much we can do if the patient does not take responsibly by sticking to the treatment plan. Effective treatment plans must be taylor made for each patient to ensure the plan is realistic. This is where good documentation is key! Documentation should always include your education of the patient about the possible outcomes (loss of limb and maybe even life), your patient's reactions to that education, the reasons for non-adherence, and what other possible alternative treatments may have been offered. I am sure you have checked out the patient's HbA1c to try to correct any chronic hyperglycemia, as well as circulation for any possible interventions to correct ischemic issues. Barring all that, it may be time to take a more palliative approach to this wound, explain it to your patient, and maintain the eschar with dry dressings to keep it dry and stable.