The Salvation Army Toronto Grace Health Centre (TGHC) is continuing to advance and build on its expertise in wound care management. The wound care program at the TGHC is recognized for its leadership in developing preventative wound care strategies, supporting staff in wound care education, and procuring funding for research and development in wound care management technologies.
The patients most at risk of pressure injuries (bed sores) are those with a medical condition that limits their ability to change positions, those who spend most of their time in a bed, and those who have medical conditions that affect blood flow, such as diabetes. Pressure injuries occur when there is a restriction of blood flow to a part of the body as a result of the pressure of lying in bed immobilized for an extended period of time. The amount of pressure needed to cause an injury varies according to the patient’s age and health.
A clinical trial to evaluate Curiato Inc.’s smart cover technology has been underway at the TGHC for over a year. The research study, now completed, assessed the value of a new data collection tool, a smart surface, positioned under the bedsheet that collects skin temperature, humidity and pressure measurements. This information is utilized by clinical staff to monitor patients more efficiently, which helps to ensure the prevention of pressure injuries.
The research team is supervised and directed by a TGHC registered nurse (RN) with clinical wound care expertise. Patients on TGHC’s patient care units, all of whom have been screened using a pressure ulcer rating scale to determine their eligibility, have been participating. The research included all patients that would be at risk as well as those that already have pressure injuries.
Michael, a patient at TGHC, was admitted on May 29, 2019 and participated in the research study. In late September of 2018, prior to his being admitted to the TGHC, Michael had been admitted to St. Michael’s Hospital (SMH) with atrial fibrillation (irregular or abnormal heart rate). After the health care team at SMH examined Michael, he was diagnosed with cellulitis (serious bacterial skin infection) in the lower part of his right leg. This condition was complicated by septic shock and led to a prolonged stay in the ICU. “Every major organ,” says Michael, “was impacted by the infection — including my lungs.”
In February 2019, Michael had his tracheostomy tube removed, and began to eat. He received limited physiotherapy (bed exercises) because he could hardly move his legs. He required the assistance of the nurses to help with his activities of daily living and the use of a lift to transfer to a wheelchair. During his ICU stay at SMH he developed pressure injuries and, because of these, putting him in a wheelchair became very painful.
In April 2019 the SMH health care team discussed Michael’s rehabilitation options. Before he was admitted to SMH, Michael was obese, weighing approximately five hundred pounds. He made it clear to the health care team that he was committed to losing weight while he received rehabilitation. “I had started to eat right and exercise,” says Michael, “before I got this severe infection.” They told Michael that the Complex Continuing Care (CCC) Program at TGHC also had a Bariatric Program. After Michael was admitted to the TGHC, an assessment by the interprofessional health care team indicated that he had three pressure injuries: one, located at the sacrum (the base of the spine), another, located on the right hip, and the third, located on his right heel. Michael was put on a diet to support pressure injury healing and help him lose weight.
He started his rehabilitation and made excellent progress. After about a month of rehabilitation, he could transition with assistance from his bed to his wheelchair. By June 2019, he was able to take himself down to the rehabilitation floor. Michael’s pressure injuries were completely healed by early November 2019. He had regained most of his independence and was using a rollator walker to remain mobile. He had on occasion gone home for the weekend to spend time with his family. Michael was discharged on December 3, 2019.
When he was admitted to the TGHC he weighed well over four hundred pounds; at his discharge date, he weighed 260 pounds. He says that the interprofessional health care team at TGHC listened to him about his desire to continue losing weight and to regain his independence. Michael is glad that he met the challenges the interprofessional health care team set for him. He is also happy that he participated in TGHC’s research project. Michael says, “After I understood what the smart cover technology would be able to do in preventing pressure injuries, I thought if this technology had been available then, I believe the recovery of my pressure injuries would have occurred quicker, or perhaps [it might have] even prevented me from getting pressure injuries all together.”
Dietary management of obesity is important to help patients reduce weight but it is also equally important for wound healing. This is a focus at the TGHC, which ensures that every patient in CCC or in its rehabilitation program is seen by a registered dietitian. Registered dietitians at the TGHC are part of the interprofessional health care team. Patients at risk for pressure injuries or suffering with pressure injuries benefit from a dietitian’s assessment.
“Good nutrition,” says Kaylem, a registered dietitian at the TGHC and wound care team leader, “is essential for pressure injury healing to take place. Wounds,” she explains, “need a proper diet to heal. If patients are not able to eat properly, or are not getting adequate nutrition — fluids, calories, or proteins — their wounds will not heal at all. At the TGHC, dietary assessments can provide interventions to prevent pressure injuries.”
The wound care team at the TGHC have been trained and have taken the International Interprofessional Wound Care Course (IIWCC), which is accredited by the University of Toronto’s Continuing Education & Professional Development office (CEPD). Nurses at the TGHC have received advanced training on pressure injury assessment and treatment. Every patient’s nurse is part of the wound team and is able to assess a patient on the risk of developing pressure injuries. If a patient has a wound that has already developed, the assessment includes looking at the whole patient — medication, diet, positioning.
“We have invested a lot of our resources,” says Kaylem, “in building our wound care team and advancing the team’s capabilities. We have a comprehensive wound care program because we have developed a team that continues to be educated and consequently furthers their experience.”
The TGHC is also in the process of becoming a Best Practices Spotlight Organization (BPSO). The Wound Care Program has been implementing several Clinical Best Practice Guidelines, including the RNAO guidelines for the assessment and management of pressure injuries for the interprofessional team. The team has been using these guidelines to direct and inform their wound care policies and procedures, and have implemented the Pressure Ulcer Scale for Healing (PUSH TOOL) to better their ability to track a patient’s wound healing and inform their practices.
By Gerry Condotta