Should Ontario be more proactive in pressure ulcer prevention?


Pressure ulcers (bed sores) can cause severe pain and decrease quality of life. They are common among the very ill, the elderly, and immobile or neurologically compromised patients. In Canada, approximately 1 in 8 patients in acute care hospitals, 1 in 11 nursing home residents, and 1 in 50 home care clients experience pressure ulcers. Patients with hospital-acquired pressure ulcers tend to stay 4 days longer in hospitals, are 7% more likely to die, and, on average, cost the health care system an additional $13,500. Although its financial burden to the health systems is not as well known as those of other diseases, pressure ulcers are expensive, costing the health care system as much as diabetes and about a third as much as cardiovascular disease.

There has been recent interest in proactive approaches to pressure ulcer prevention around the world. In the United States, there is an emerging belief that hospitals should not be reimbursed for serious complications that should never occur in a safe hospital. Pressure ulcers have been designated as one of the “never events”: medical errors that are identifiable and reasonably preventable through the use of evidence-based guidelines. As a result, hospitals are no longer reimbursed for additional care for hospital-acquired pressure ulcers. This move by the Centres for Medicare and Medicaid Services aligns financial incentives with patient safety and quality of care.

In Japan, recent policies reimburse hospitals approximately 50 yen (~ $0.50) per patient per day if they establish a pressure ulcer team including both physicians and nurses, introduce a standardized clinical protocol for pressure ulcer management, and provide adequate preventive support surfaces to at-risk patients. Hospitals also receive an incentive reimbursement of 5,000 yen (~ $50) per patient if they employ a government-certified wound care specialist, develop a comprehensive pressure ulcer management program, and conduct on-the-job training for their staff in pressure ulcer management. Preliminary results suggest that the proposed structure (i.e. staffing, guidelines, and equipment), and processes (i.e. risk assessment, wound documentation, team collaboration, and training) improve healing rates and reduce hospital-related costs.

Like the United States and Japan, Canada has an aging population. By 2026, when many of the baby boom generation will be retired, the proportion of elderly will increase from 13.2% today to 21.2%. Elderly patients are at risk of developing pressure ulcers because of immobility, poor nutritional status, impaired mental status, and incontinence. Over a 15 year period, the percentage of hospital patients reporting these morbidity conditions increased from 9% in 1994 to 17% in 2008.

In Canada, it is challenging to prevent pressure ulcers, especially in acute care hospitals. A high proportion (approximately 38% as of 2010) of hospitals reported a financial deficit. To cope with a high demand for hospital services from an aging population, hospitals strive to discharge patients as early as they can. As a result, discharged patients with hospital-acquired pressure ulcers are managed in the community. This arrangement of transferring care for pressure ulcers from acute to community care does not incentivize hospitals to improve prevention. This arrangement also subjects pressure ulcer care to variation in the quality of care transition, including problems with care coordination and documentation. Consequently, the lack of emphasis on prevention in acute care, coupled with an aging population, could lead to a gradual increase in the burden of pressure ulcers over time.

Prevention policies in Canada are generally formulated based upon their supporting evidence. For example, the Ontario Health Technology Assessment Committee recommends that high quality foam mattresses should be provided to all persons in an acute care setting, high quality support surfaces should be used during surgical procedures lasting longer than 90 minutes, and high quality foam mattresses should be used for all persons accessing emergency room care. While these recommendations are grounded in evidence, there is little data about how widely they have been implemented in practice.

The Canadian approach to pressure ulcer prevention is different from the accountability approach used in the United States or the incentive approach used in Japan. Given the impact of preventable pressure ulcers on patients and the healthcare system, we think it is time for Canada to proactively consider accountability or incentive measures to improve uptake of evidence-based guidelines. What do you think?

To ensure better uptake, should pressure ulcer prevention policies in Canada be more proactive?

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Ba’ Pham is a research associate with the Toronto Health Economics and Technology Assessment Collaborative, University of Toronto. Laura Teague is a Nurse Practitioner at St. Michael’s Hospital in Toronto. Nancy Parslow is a Clinical Co-Ordinator in Edterostomal Therapy Nursing and Wound Care at the University Health Network. Connie Harris is a Senior Clinical Nurse Specialist, Wound and Ostomy at Red Cross Care Partners. NP, CH, LT are panel members of the Registered Nurses’ Association of Ontario Best Practice Guideline for risk assessment and prevention of pressure ulcers.

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27 comments

  1. Ba' Pham

    Like over 200,000 other Canadian families, my family is with a love one who is at risk for pressure ulcer in a nursing home. Throughout my regular visits with my Mom, I’ve seen front-line practitioners working hard to provide great care for patients with wounds.

    Many wounds are preventable, providing that the right prevention policies are in place. Funding is often allocated to treatment, but not prevention, ensuring an open pipeline for wounds to come and front-line practitioners to cope. I’m talking about the lack of funding for off-loading devices to prevent diabetic leg ulcers, compression stocking to prevent venous leg ulcers, and high-density foam mattresses to prevent pressure ulcers. These preventive measures are supported by high-quality evidence (just in case that could be used as an excuse for not to act).

    I’ve just come back from attending a meeting of a wound care interest group that aims to affect positive changes in wound care policies. I’ve observed plenty of open discussions among many passionate individuals representing the interests of front-line practitioners and government. That gives me hope that positive changes in prevention policies would eventually come.

    Another venue to affect positive changes in wound care policies is here. I’m starting this discussion because Healthy Debate is the venue that facilitates interactions between the public and policy-decision makers.

    You’ve seen how social media affects positive changes in places where hopelessness is the norm – the Arab Spring of 2011 in Tunisia and Egypt would come to mind. Funding policies for wound prevention in this country need to change. Let’s see how social media could affect positive changes in funding policies for wound prevention. It’s worth a try…

  2. Laura Teague

    Thank you Ba’ for your opening comments.

    My position is that of a clinician, PhD student and health policy change advocate. I am the past president of the Ontario Woundcare Interest Group and RNA) BPG panel member for most of the wound care BPG’s.

    The cost of wound care in Ontario is $ 1.5 Billion. This is likely an underesitmate as data collection for wounds ( pressure ulcers, lower extremity ulcers etc) is rarely done.
    In a recent publication in the International Wound Journal by Chan et al (2012), the monthly cost of pressure ulcer care in community dwelling spinal cord injured residents in Ontario is $4750. This translates to almost $60,000/annually per patient.
    Some of the issues that I face as a clinician is lack of timely access qualified clinicians that can assess and recommend optimal devices for offloading. This is important from a secondary and tertiary prevention perspective. Furthermore, when patients are deamed to be surgical candidates, access to convalesance and rehabilitation is problematic as these patients do not “fit” with the rehabilitation centres’ funding structures. Their hands are tied. The patient continues to accrue $4750/month in wound care costs that could be avoided.

    An Ontario Strategy for wound care is urgently required. This must start with shifting from treatment to prevention. Incentives to organizations/systems need to be in place for prevention. Access to evidence based care is critical, and this includes to health care professionals in various disciplines to manage some of the complex issues. Pressure ulcer prevention is a multidisciplinary and system issue that will require structure and process changes that cross sectors. Incentives need to be offered to regions (not individuals or single organizations) who collaborate to prevent and treat pressure ulcers using best practice.

    Data collection using the same nomenclature needs to be in place, with risk asjustment so that we can identify who is doing well and who is struggling .

    Timely access to publically funded health care disciplines (Chiropody , OT, PT. Dietitians) would help with special assessments and timely applications to access special devices.

    No matter where the person is in the health care system, access to pressure ulcer prevention is required. Access to secondary and tertiary prevention is also required.

  3. Jon Sachs

    Hi there,

    Thanks for the interesting article. Two questions.

    1. According to the stats in the article,ulcer incidence is lower in the community (home care, nursing homes) than in hospitals. Does this imply that rapid discharge has its advantages? Do you know what proportion of ulcers are acquired in hospital vs. in the community? Just trying to get a better sense of the ‘root’ of the problem.

    2. The article discusses Canada, but only really focuses on Ontario in terms of data and policies. Are there any provinces that are doing particularly well at ulcer prevention? Is Ontario considered a leader in this area, though still suffering from moderate-to-poor outcomes?

    Thanks!

    Jon

    • Ba' Pham

      Hi John,
      As I understand it, patients are at high risk of developing pressure ulcers at the peak of their illnesses, which tend to coincide with their time in acute care hospitals.

      There have been attempts to track patients as they transit from acute care to long-term or home care to see which settings are associated with high setting-acquired pressure ulcer risk; although these attempts are generally not completed (as I understand it). However, we wouldn’t be too far off to infer that patients are at high pressure ulcer risk in the hospitals because they are relatively sicker there (perhaps with the exceptions of individuals in nursing homes with permanent immobility).

      With regards to your second question, the situation in other provinces is not vastly different than that in Ontario, even though I only understand this via informal discussion with others at wound conferences. I know Nova Scotia has put in place a tracking system for detailed wound outcomes, which is essential for planning of prevention policies. Let’s see if we hear from other provinces on this blog.

      Best, ba’

  4. Karen Campbell

    Fantastic discussion, I have seen many frail elderly people develop an acute illness end up in acute care and return with a pressure ulcers. This is especially true with individuals who fracture their hip. I conducted a study in London On we were able to eliminate all pressure ulcers on the heels in this group with a simple device that lifted the heels of the bed. I feel ashamed that in this day and age, we can save lives with technology but we have no formal pressure ulcer prevention program for our most vulnerable patients. This needs to change.

    • Ba' Pham

      Hi Karen:
      The next posting asks about prevention policies elsewhere in Canada. I’ve only limited understand this issue. Would you be able to help us out with your comment on this issue?

      Many thanks.

      Best, ba’

  5. Ann-Marie McLaren

    I would like to thank Ba, Laura, Nancy and Connie for initiating this blog and discussion. My position as a primary care clinician (chiropodist) with a master’s degree in wound healing and past member of OntWIG executive, I agree that Ontario needs to take a more proactive position with regard to the prevention of pressure ulcers.
    Both Ba and Laura have presented some of the statistics and literature regarding the impact of pressure ulcers. I wanted to comment on the devastating effects I have witnessed by patients who have suffered after developing a preventable pressure ulcer on their heel.
    Often these patients are adversely affected by pain, inability to ambulate and some end in amputation of the limb. The most distressing situations occur with the patient that has already had an amputation of a limb, unfortunately, they often develop a pressure ulcer on the remaining foot. These high risk patients never have good outcomes. Often the non-blanchable skin behind the heel is never identified until there is a full blown blister, black area or the patient complains of discomfort.
    Our high risk patients need to be identified using validated tools, including intense surveillance, appropriate interventions (off-loading devices, repositioning, advanced pressure relief surfaces), and concise documentation. This requires an interprofessional team approach but is not the norm in practice.
    Specifically, chiropodists are an important part of the team but many are not included in funded interprofessional teams in the Province of Ontario. Ontario needs to be proactive and ensure that all members of the interprofessional team are available to prevent and treat pressure ulcers.
    I would like to see the Ontario Government include all members of the health care team in their overall budget and planning for Ontarians. The burden to the patient, their family and us as a society is high. I would welcome any opportunity to participate in moving our health care programs forward toward prevention…one step at a time, one heel at a time, one limb at a time.

    • Lyndsay Orr

      Thank you Ann-Marie for your insight as an Interprofessional team member who specializes in foot wounds. I am also a member of the Interprofessional team as a Physiotherapist(PT). I too share many of the frustrations documented in the above comments. As a hospital clinician, I often see patients who have been dealing with pressure ulcers for a period of time and need further management or acute management due to sepsis. %featured%In almost all of the cases that bring these patients to hospital, their pressure ulcer was preventable if the appropriate education, awareness and equipment were provided at the time when it was required.%featured%
      Pressure Ulcer Management is often treated based on a Diseased Based Care Model vs. a Wellness Model which if part of most Chronic Disease Prevention and Management (CDPM) Frameworks. Prevention is not a priority, and a solo provider approach is implemented for patients in the community with a CCAC nurse for dressing changes only. Reactive and episodic care is given based on the status of the wound. Chronic wound patients often return with new areas of breakdown. A more progressive Wellness Model of care would focus on education, prevention, as well as an integrated, interdisciplinary team approach which is patient centered and evidenced based. Increased awareness and proactive intervention for pressure ulcer prevention needs to be made a provincial priority similar to the Chronic Disease Prevention and Management initiatives for Diabetes and Hypertension.

      • Ba' Pham

        Hi Lyndsay:
        I fully agree with you about your comments on reactive and episodic care.

        May be it’s worth pointing out that in Ontario, there are initiatives such as the Integrated Client Care Project which aims at reorganizing wound care in the community to improve wound outcomes. Changes are however coming very slowly.

        Best, ba’

    • Ba' Pham

      Hi Ann-Marie:
      As I understand it, interprofessional teams are taking care of patients with wounds in other countries. See for example,

      the network of 10 specialized wound care centers in Germany (Coerper et al. Arch Surg 2004),

      specialized wound care team in the US (Sholar et al. Annals of Plastic Surgery 2007),

      and the organization of wound healing services in Denmark (e.g., Gottrup et al. Am J Surgery 2004).

      Best, ba’

    • Rick van der Heide

      Ann-Marie,
      Thanks for your comment. I fully agree with you. My frustration is seeing our profession (Chiropody) not being able to contribute as fully due to lack of publicly funded positions. Chiropodists are increasingly going into private practices due to a lack of funded positions. While working in my private practice I found the only way I dealt with wounds was at my own expense.
      Where we typically see funded positions is in CHCs, FHTs and some Diabetes Teams, not in hospitals or longterm centres where pressure ulcers are more likely.

    • Linda Murphy

      Thank you for this comment Ann-Marie. You capture beautifully the impact on patients and their families. I doubt I will ever forget the experience of explaining to my mother-in-law that her leg had to be amputated because of a pressure ulcer that would not heal. As she had Alzheimer’s disease, this was repeated many, many times – as was her anguish and confusion until her death two years later.

      Now my own mother is in a wheelchair full time and I am determined that this will not happen again on my watch. My expereince is that it takes considerable effort on the part of family to get routines established to ensure that Mom is repositioned regularly throughout the day in a tilt chair (that we purchased) or for short breaks periods in bed during the day.

      I agree with your recommendations but I beleive that one of the factors is inadequate staff time or lack of continuity of staff assigned to a person – whether in hospital or community settings. Retirement homes are providing care to an increasing number of seniors needing more complex care (my parents are a good example of this) and these practices are not ingrained in their staff although many are very skilled and caring in other ways.

  6. Karen Campbell

    In answering Jon’s question, most pressure ulcer occur in acute care, therefor the incidence in high in acute care while the prevalence is higher in LTC, Complex Continuing care and Rehab. There are some exceptions to this but generally this is the case, there are multiple studies that show with many patient populations prevention programs do work, and cost less to the health care system than treatment. That is not factoring in the human cost to people who develop pressure ulcers, pain, suffering. loss of limb and death. The cause of pressure ulcers in multifactoral, therefore an inter-professional team is required to prevent pressure ulcers. I have been a wound care clinician for many years and now am the field leader for the masters of Clinical Science in Wound healing at Western University. This is an inter-professional clinical masters degree.

  7. Ba' Pham

    Hi there,
    Let’s keep our posting short. Here are the funding options we’ve asked for.

    1. Funding for off-loading devices to prevent diabetic leg ulcers.
    2. Funding for compression stocking to prevent venous leg ulcers.
    3. Funding for pressure-redistribution foam mattresses for high-risk patients in acute, long-term and home care.

    We should fund these things because they improve health (i.e., saving live and improving quality of life) and they are cost saving to the health system(s).

    What do you think?

    • Jacqueline Baptiste-Savoie

      Ba, Nancy and Laura, thank you for opening up this very important discussion. I absoutely agree that funding should be available for all patients for devices and equipment to prevent and treat the many chronic wounds we as a group encounter in practice. We all see the patient with the chronic venous limbs in the ER every 6 weeks because they cannot afford to purchase the maintenance stocking once the compression wraps have been discontinued. The revolving door for patients with chronic wound and conditions that lead to wound are often a result of their inability to pay for the prevention/maintenance products. To cost to the healthcare system with these ER visits not to mention their quality of life far outweights the cost of the devices and equipment.

  8. Ba' Pham

    Hi Jon,
    Please see Karen’s comment above. Best, ba’

  9. Marg Harrison

    Ba’ & colleagues I note compression stockings in your 3 requested funding options. After a decade of research implementing best practices with the community leg ulcer population, the quest is still on for this vulnerable group. The evidence is unequivocal (since a 1998 Cochrane review) regarding compression bandages for venous/missed etiology ulcers. Yet many people were receiving homecare for this problem with a wide variety of ineffective & expensive care including twice daily visits for simple dressings. Now in 2013, healing rates are greatly improved & individuals are off service quicker. The next frontier is with secondary prevention & the use of stockings. This is neither assessed nor monitored nor reimbursed typically. How wise is that with such a common chronic, recurring condition? Thank you for raising it as a priority!

  10. Karen Laforet

    Incredibly timely! Ba’ thank you for initiating this important discussion.

    My position is as an clinical lead/administrator and current president of the Ontario Woundcare Interest Group. Thank you Laura for articulating the need for policy changes.

    Current funding is single service, treatment based. This type of care model is unsustainable.
    The need for funding prevention is critical so yes, I support the funding options presented here. However,%featured% funding alone will not solve the problem. Shift needs to happen regarding how health care is defined, measured as well as funded.%featured% For example the conceptual framework for outcome based funding is moving in the right direction–it needs work and it needs to be integrated within a pan-provincial strategy.

    In addition, there needs to be accountability measures in place within acute, home and LTC organizations to ensure Ministry policies are carried out and down to where it will do the most good–the client/patient/resident and the ones providing care every day.

  11. Estrella Mercurio

    Hi Ba,
    Congratulations and thanks for leading this forum – it is with great hope that, like you, it can lead to a direct influence on policy makers/policies related specifically to wound care.

    I agree wholeheartedly with all of the previous comments. In a forum we used to have, probably 5-6 years ago, I had challenged the group (called Innovator’s Group) to help influence policy makers to make changes to our funding model (from treatment to preventative). The case I pointed out then was the funding for LTC PU cases where there were no funds if the PU was either Stage 1 or 2, but yesm, no problem if it was Stage 3 or 4. At that time, I stated that in the States, they actually gave incentives for LTC facilities who showed no incidence of new PU in their facilities for the year. We all know that the cost of treatment is far greater than the cost of preventative strategies.

    In home care, CCAC will fund the cost of therapeutic surfaces, mostly after a client develops PU, but only for a month. After which the client is told to continue renting the surface through CCAC, rent from somewhere else or buy the mattress. Sometimes, we can negotiate for an extension of its use without cost to the client, but only after “justifying” its continued use. Oftentimes, when it is not approved and the surface is pulled out, the client comes back with a new PU if the PU had healed or the PU deteriorates further.

    Prevention does not seem to be in the radar – from any angle, this should be the way to go if we have to justify the judicious use of our health tax dollars.

  12. Meg Carley

    Dear Ba’ and colleagues,

    Your article identifies the issues precisely and I agree with comments left by others.

    I agree that we should be more proactive about pressure ulcer prevention in addition to leg ulcer prevention. This is a very important issue. I will share this forum with as many family members, friends, and colleagues as possible and I urge others to do the same.

    I don’t have anything more to add, but just wanted to say thank you for posting this article.

    Best regards, Meg

  13. Kathleen Klement

    Ann-Marie,%featured% I could not agree more that the burden on the patient, their families and caregivers is high. I feel that most patients truly want to do their part in prevention and management of their conditions, but the costs are such a significant barrier.%featured%

    I feel that our healthcare system focuses too narrowly on caring for the acute patient and does not spend enough time on prevention and educational programs. Furthermore, a collaborative approach is seemingly a “new” concept among wound care teams. Lyndsay touched on this in her post, describing the solo practitioner model.

    The two key points that ought to be considered are prevention/education programs and inter professional collaboration. As a Canadian Certified Pedorthist, I feel that the allied health clinicians are under utilized in the management of many wounds, including pressure ulcers.

    I think that prevention policies need improvement and including accountability or incentive measures might prove effective.

  14. Linda Murphy

    Thank you to Ba’ Pham for this article and to commenters for keeping this discussion going. I have a keen interest in this topic as my family was shocked when my mother-in-law had to have her leg amputated as a result of a heel pressure wound while living in a nursing home. As she also suffered from Alzheimer’s we had to comfort her over and over again during ‘recovery’ from this trauma. We are now trying to use lessons learned from this experience to prevent a similar outcome for my mother who lives in a retirement home (regularly inspect her for sores, encourage regular re-positioning and exercises for this group, etc.). Mom also has Alzhiemer’s disease and spends her days in a wheelchair and recently began to develop sores on her buttocks despite a custom wheelchair and seat cushion. Despite good intentions on the part of staff and family, the reality is that regular ‘repositioning’ is time consuming and staffing levels make it difficult to address the needs of many of the residents who can no longer shift positions on their own. We are lucky enough to be able to hire additional caregivers while my parents wait for their ‘numbers’ to come up for LTC beds, but I suspect that their situation will not improve dramatically in this regard.

    %featured%We DO need prevention guidelines for this – for use across the community and acute care sectors AND to help make families more aware of effective strategies to prevent the pain and anguish that many suffer from pressure ulcers and its consequences%featured% – not to mention the additional health care costs.

  15. Grace Forget

    I always think negative type incentives to provide good care tend to be ineffective. And the way such a program is implemented is almost always in an ‘all or nothing’ manner. I truly believe that preventable pressure wounds should be prevented whenever possible but, in the geriatric world,
    we know that all pressure wounds cannot be prevented. It is doubtful that any program of consequences would take that into account.
    Geriatricians recognize that at end-of-life, especially with residents with dementia, skin breakdown can be part of the process of dying and unavoidable. This information was presented at the last CAWC conference. I also heard this stated by a geriatrician from California at a conference held by the International Federation on Aging. We see it happen in our nursing home despite every intervention possible. The geriatricians explain that the resident’s skin is shutting down just like their other organs and that breakdown cannot be prevented in these cases.

  16. MIchelle Todoruk-Orchard

    Thanks Ba’ for raising these important issues.

    I am the Clinical Nurse Specialist for the Home Care Program in the Winnipeg Region. I am the Lead for the Home Care Wound Care Best Practice Team and also Chaired the Regional Wound Approach Steering Committee for 7 years. I wanted to comment on what is currently happening in Manitoba to address Jon Sach’s questions on other provinces.

    Regarding Pressure Ulcers- in Dec 2010, Manitoba Health made all Stage 3, 4 and X pressure ulcers mandatory reporting as a Critical Incident (CI). A interdisciplinary team huddle must occur immediatley and all causes identifed and addressed asap. For our Region, this has allowed Patient Saftey to begin to investigate each incident and identify system changes that need to occur to move to pressure ucler prevention and early intervention rather than the reactive and episodic care that Lyndsay Orr pointed out that currently occurs across the care continuum and frustrates many of us as clinicans.

    The Region has had Regional Wound Recommendations since 2003 but uptake has varied across sites and programs. The majority of these Recommendations have now been updated by an interdisciplinary team of experts with the levels of evidence embedded and are now Clinical Practice Guidelines (CPGs). The PU CPG was released in March 2013 with a large regional PU Prevention campaign.

    In the Home Care we have had an uncapped Therapeutic Sleep Surface (TSS) Program since 2003. Client’s assessed as at risk or with a Stage 1 or 2 PU are assessed for a foam pressure reduction mattress and all clients with mulitple areas of pressure or a Stage 3,4 or X PU qualify for a presure relief TSS ( powered or non-powered)

    Since 2010 in HC we have also now implemented the following:

    – All Home Care Nurses receive 2 full days of wound care education with a primary foucs on PU prevention and management ( with a large case study componenet to assist with knowldege translation)
    – All 400 Home Care Nurses have been trained to do a basic TSS Assessment
    – All HC clients are assessed for PU risk on admission, annually or sooner if their health condition changes using a standradized risk assessment tool ( Braden scale). Based on identifed risk specific prevention interventions must be implemented and automatic referrals must be generated to OT to address pressure, friction and shear, Nursing to address continence concerns and the Registered Dietitian to address nutrition.

    Regionally we are working with an interdisciplinary team to standardize the criteria and processes for TSS assessment and reassessment from acute care to community.

    For Lower Leg Ulcer prevention agree 100% that funding needs to be considered for graduated compression stockings (GCS). We see too many repeat lower leg ulcer clients despite much teaching on the need for compression for life. Clients generally indicate it is inablilty to afford the GCS that prevents them from obtaining or replacing stockings. At times we do keep clients on service for maintenance lower leg compression wrapping if there are no other options for the client to receive the ongoing compression needed.

    In Home Care (based on our invovlement with Marg Harrision on the Canadian Bandaging Trial) we now complete a comprehensive lower leg assessment on all clients with lower leg edema.

    For those with no ulcerations, we do teaching, arrange ABPI/toe pressure testing and work with the client and primary care provider to try and get the client into GCS before an ulceration occurs. This is reviewed annually for HC clients.

    For those clients with lower leg uclerations, we arrange vascular studies and initate compressoin therapy as soon as possible which has improved healing rates. All Home Care nurses attend a full day venous/mixed/arterial lower leg ulcer/compressionwrapping module.

    Hope that helps shed some light on activity in Winnipeg, MB!

  17. Mike Piccin

    This is very interesting discussion, and in all cases here I agree that prevention is the key to success. In regards to accountability in LTC there is now new technology that validates repositioning of residents which indicates and validates all movements on the residents bed. This is a thin sensor matt put underneath the residents mattress that records biometric movements on a timeline over a 24 hour period, holding night staff accountable.

    The system works off of the wifi in the LTC home and responds to an IPOD letting the staff know 15 minutes before the repositioning time is here, the staff then does the turn then reports right there in the ipod. This system also alarms to the ipod when the resident gets in, and out of bed instantly which has shown a drastic improvement of fall reduction. You can also mine the system for trends of resident activity, se when their high rish times are, and put care plans in place to lower or eliminate risk factors. The system also monitors residents vitals completely touch free, they don’t even know its there and do not alarm in the room.

    These units have just recently been released to Canada and so far have been a huge hit in Ontario, Advanced healthcare is the supplier of the BAM smartbed systems and is offering free trials to all ltc homes that may be interested.

  18. Alina

    My mother acquired a pressure ulcer at a Ontario hospital 10 months ago. Due to lack of deligent carrot went from stage 1 to non stageable in6 weeks. She’s had infection after infection and does not qualify for long term care. It’s been a true nightmare.

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