november 2012 wounds 3
TRANSCRIPT
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STAGE I
STAGE II
STAGE III
STAGE IV
SUSPECTED DEEEP
TISSUE IN
JURY
UNSTAGEABLE
ARTERIAL-L
EG
MIX
ED-LEG
VENOUS-LEG
ARTERIAL-F
OOT
MIX
ED-FOOT
NEUROPATHIC (L
OPS)
ABSCESS
BURN
FISTULA
PILONID
AL SINUS
SKIN TEAR
SURGICAL C
LOSED
SURGICAL O
PEN
TRAUMA
TUMOR
# wounds documented ACUTE CARE - ALL WOUNDSCA-CENTRAL, EAST & WEST
WOUNDS
Canada’s Man in Motion Rick Hansen is bringing attention to a serious and growing health issue
An Ounce Of PreventiOn is WOrth
A POund Of cAre
ph
oto
: Vin
ce
nt
L. c
he
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AN iNdepeNdeNt SUppLeMeNt froM MediApLANet to tHe NAtioNAL poSt
overcoming adversityYou are not alone
Made-in- CanadaWound innovations
Acute WoundpreventionWatch out!
November 2012
FACTS YOU DID
NOT KNOW ABOUT WOUNDCARE
FACTS
3
AN iNdepeNdeNt SUppLeMeNt by MediApLANet tO tHe NAtiONAL pOSt2 · NoV 2012
T o most of us, a wound is a cut or scrape. For many, a wound is a critical health issue with serious conse-quences including pain, infection, hospi-
talization, confinement, reduced qual-ity of life, depression and sometimes even death. Overshadowed by higher-profile health conditions, wounds are not recognized as a major issue despite having an annual economic burden of $4 billion in Canada.
National Stakeholder Round-tableIn June, thirty-five leaders repre-senting Canadian healthcare met to start a conversation about trans-forming service delivery and improv-ing value for money in wound preven-tion and care. Co-chaired by Janet Davidson and Tom Closson, both highly regarded health executives, the group agreed that wounds must be made a national priority and con-cluded Canada can do a better job of improving wound outcomes.
Linking innovation, quality and the economy
One of the big ideas coming out of the June Round-table was the creation
of a Canadian centre of excellence focused on innovation in wound care. According to Dr. Anne Snowdon, Chair, Ivey Centre for Health Innovation and Leadership, Canada has an innovation deficit and is ranked 13 of 17 among OECD countries. Speaking at the Can-adian medical technology industry association (MEDEC) AGM, Snowdon made the connection between innov-ation as a driver for economic growth and health improvement. Further, the Council of the Federation’s Work-ing Group on Health Innovation is advancing innovation as a path to bet-ter system value. Their Report From Innovation to Action highlighted the Canadian Association of Wound Care’s and Canadian Diabetes Associa-tion’s compelling evidence for quality improvement for diabetic foot ulcers, one type of wound.
There already exist pockets of outstanding wound innovation in Canada. Project SMART at the Uni-versities of Calgary and Alberta has invented an undergarment, dubbed Smart-e-Pants, that delivers electrical stimulation to areas susceptible to pressure ulcers. The Rick Hansen Institute is yet another example of exceptional leadership in supporting innovation in wound care.
Just as there are centres of excel-
challENgES
canada’s hidden epidemic of wounds costs the system billions
The World Health Organization issued a warning that the major global health threat is not communicable, but non-communicable disease like diabetes — a condition where wounds are an all too common complication
1 Wounds cost Canada at least $4 billion annually
2 Cost to grow by 30 percent in the next decade because of dia-
betes and ageing
3 It is estimated that 30 to 50per-cent of all health care involves
wounds
4 In the community, 50% of nurs-ing visits involve wound care
delivery
5 34 to 3 7percent of persons receiving community care
have a chronic wound
6 24 to 31 percent of persons in an acute or non-acute setting
have a pressure ulcer
Maureen Latockiexecutive director,Wound Care Alliance.
FActS AnD FiGUReS
“ pressure sores are the No.1 preventable complication in the health system”
Bill BarrableCeo, rick Hansen institute, discussespressure ulcers.
We RecommenD
pAge 8
The next frontier p. 4 innovative technologies
Teamwork p. 7Moving long term care ahead
WoUNdSfirSt editioN, NoVeMBer 2012
Responsible for this issue:Publisher: William [email protected]: michael SinananContributors: Dr. Ralph S. Da costa, Robb Dunfield, nadine henningsen, phalgun Joshi, maureen Latocki, Ray Racette, Joe Rosengarten, Klaus Stitz
Photo Credit: All images are from iStock.com unless otherwise accredited.
Managing Director: Joshua [email protected]
Distributed within:national post, noVemBeR 2012this section was created by mediaplanet and did not involve the national post or its editorial Departments.
Mediaplanet’s business is to create new cus-tomers for our advertisers by providing read-ers with high quality editorial contentthat motivates them to act.
A charitable not-for-profit health care organization, Saint Elizabeth, has partnered with The Assembly of Manitoban Chiefs (AMC) with the aim of preventing diabetic foot ulcers to reduce the number of related amputations.
Tracy Scott, Program Lead for the First Nations, Inuit and Métis Pro-gram at Saint Elizabeth, said, “It is a truly remarkable partnership and it is unique in Canada. At Saint Elizabeth we believe in spreading our knowledge and technology as far as it can go to make a greater contribution to society, and we have made a special commitment to First Nations communities.”
The Manitoba First Nations Patient Wait Time Guarantee project was a joint initiative between Saint Elizabeth and AMC. The project was designed to implement a framework that would reduce the significant impact of foot ulcers and the dispro-portionate number of amputations.
Early preventionScott said, “The prevention of ulcers is the key. Regular foot assessments are important for individuals living with diabetes. Developing clinical best practice guidelines and deliv-ering health care provider education were key components of the project. We were able to make significant progress in this project and now, we hope to see the project recommenda-tions rolled out provincially or even country wide.”
Scott explained that diabetic foot ulcers are largely preventable: “A proper fitting pair of shoes can often stop the ulcer from forming in the first place; the foot will be properly protected and not sustain the initial
injuries that, further down the road, can lead to an ulcer. The challenge, particularly in remote and isolated communities is having access to proper fitting shoes.”
Mabel Horton, the eHealth/tele-Health/Panorama Coordinator for AMC, believes that education within First Nations communities is essen-
tial, “We need to target those in their early teens. There are children as young as 12 with type 2 diabetes.”
Make the right choiceHorton explains that there are a num-ber of factors that contribute to why younger people are getting diabetes, “The isolation of the communities means that food is very expensive, healthy food choices are often not available and there is less fishing and hunting today. Access to healthy foods, including traditional foods, is a real concern.”
The partnership is definitely hav-ing a positive effect. Scott explains, “We have common goals, a com-mon vision and a common passion. Involving First Nations in identify-ing the complex underlying issues and what needs to be done is the key to success.” For more information on this project visit: www.fnwait-timesguarantee.com.
Partnering for better healthDiabetes is between four and five times more common amongst Manitoba First Nations (MFNs) than all other Manitobans, and MFNs are between eighteen and twenty-three times more likely to require an amputation as a result of a diabetic foot ulcer.
JOE ROSENGARTEN
COURTESY OF THE CANADIAN DIABETES
ASSOCIATION
MAUREEN LATOCkI
Mabel Horton R.N., M.P.A.eHealth telehealth/panora Coordinator.
cARinG FoR YoUR Feet
Steps for healthy feet
1 Look for signs of redness or blisters on your feet. This
shows your shoe may not fit prop-erly.
2 Wash your feet daily. Dry well, especially between your toes.
Apply a moisturizer to your feet but not between your toes.
3 Do not soak your feet.
4 If you are unable to reach your toes or do not have feeling in
your feet, have a healthcare profes-sional trim your toenails for you.
Footwear
1 Shake out your shoes before you put them on.
2 Wear shoes at all times, indoors and out.
3 Buy shoes with closed toes as they protect your feet from
injury.
4 Change your socks every day.
5 Buy shoes late in the day as feet tend to swell.
6 Have your shoes profession-ally fitted by a footwear spe-
cialist.
FoLLoW US on FAceBooK AnD tWitteR!www.facebook.com/MediaplanetCAwww.twitter.com/MediaplanetCA
or at risk of developing a wound. By mobilizing Canada’s talent in the private and public sectors, and apply-ing their efforts to improving wound management, the centre could also contribute to Canada’s economy by attracting R&D and high quality jobs, while improving the quality of life for millions of Canadians. In 2009, the Australia government provided an investment of $28 million to cre-ate a Wound Innovation Collabora-tive Research Center in partnership with academia and the private sector. Today, they have a combined budget of $100 million and have created 60 new FT jobs. That’s a return on investment (ROI) of 3:1.
Investing today will reap bene-fits tomorrow
Just as the saying “an ounce of pre-vention is better than a pound of cure” goes, investment today in a Canadian centre of excellence will produce a handsome return tomorrow. Miti-gating the enormous economic and social toll of wounds calls for nothing less.
Find the Wounds National Stake-holder Round-table Report on Face-book.
lence for arthritis and stroke, momen-tum is growing among the academic, research, and commercial wound care communities in support of a centre focused on wounds. A centre could drive world-class R&D, raise the standard of practice and improve outcomes for persons with a wound
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AN iNdepeNdeNt SUppLeMeNt by MediApLANet tO tHe NAtiONAL pOStAN iNdepeNdeNt SUppLeMeNt by MediApLANet tO tHe NAtiONAL pOSt NoV 2012 · 3
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NONE PROVIDED
STAGE I
STAGE II
STAGE III
STAGE IV
SUSPECTED DEEEP
TISSUE IN
JURY
UNSTAGEABLE
ARTERIAL-L
EG
MIX
ED-LEG
VENOUS-LEG
ARTERIAL-F
OOT
MIX
ED-FOOT
NEUROPATHIC (L
OPS)
ABSCESS
BURN
FISTULA
PILONID
AL SINUS
SKIN TEAR
SURGICAL C
LOSED
SURGICAL O
PEN
TRAUMA
TUMOR
# wounds documented ACUTE CARE - ALL WOUNDSCA-CENTRAL, EAST & WEST
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challENgES NEWS
acute care: Don’t take it for granted
Pressure ulcers and wounds can be suffered when a patient is receiving treat-ment for an acute injury. These injuries can be the
first trigger in a dangerous chain of events for the patient.
Laura Teague, an Advanced Practice Nurse on Wound Care, explained: “From a clinical per-spective infection is the biggest complication. If the infection is not treated in time it can find its way to the bone, which can then lead to a deadly blood infection.”
Best practiceThere are many causes of pressure ulcers and sometimes they can be avoided. Teague said: “If proper risk assessment is done and there is a high standard of care then problems can be avoided. Sometimes pressure ulcers are unavoidable, they can occur unintentionally, as a result of treatment.”
Teague has been part of a research project that aims to find out whether or not there is more that can be done to detect pressure ulcers and wounds at an early stage. She said: “We aim to
develop a tool that will consistently identify patients receiving treatment for acute injuries who are at risk of pressure ulcers. We want to develop at profile of those who are most at risk.”
Teague explained that better com-munication is required throughout the Canadian health care system. “The way that different hospitals and care organizations collect their data can be disparate. It makes it so difficult to make comparisons: we require better systems to collect data consistently.”
Reward preventionThe prevention of these ulcers can be tough, Teague said: “In some cases, the only way the patient can have access to the adequate care is if they sustain the injury. We need to be more proactive. We need to get to a place where we reward prevention in health organizations. That would be an important project.”
Teague is an advocate for best prac-tice guidelines. She herself has con-tributed to three sets of guidelines on the subject of wound care, produced by the Registered Nurse Association
of Ontario. She said: “These guidelines help to develop frameworks for pro-gram planning and they also help you to measure the impact of your imple-mentations.”
JOE ROSENGARTEN
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15% OF ALL DIABETES
PATIENTS DEvELOP A DIABETES FOOT ULCER IN THEIR
LIFETIME
1FACT
AN iNdepeNdeNt SUppLeMeNt by MediApLANet tO tHe NAtiONAL pOSt4 · NoV 2012
DR. RALpH S. DA COSTA
The next frontierNew wound technologies are paving the way
Chronic wounds represent a signifi-cant burden to patients, health care professionals, and health systems.This burden is rapidly growing due to an aging population, the emergence of hospital acquired infections, and the epidemic of diabetes and obes-ity. While modern wound care has advanced significantly over the past decade, the emergence of new tech-nology offers hope for significant improvement in diagnosis, treatment and monitoring - at the individual patient level.
Early detectionToday, diagnosis of wound infection relies on clinical judgment, which varies widely, and culture-based tests, which take days to yield results. An accurate (image-based) method that identifies infection addresses the need for rapid point-of-care wound
care diagnostics. Early recognition of infection, identification of pathogenic microorganisms and assessment of pathogenic load have a major impact on delivering optimum wound man-agement and improved healing rates. WOUNDCHEKTM developed and sold by Systagenix represents the world’s first rapid, point-of-care test for the assessment of protease activity in chronic wounds. Relying on a wound swab sample, WOUNDCHEKTM can aid wound assessment and help clin-icians target advanced wound care therapies more effectively.
Ontario innovationTo complement this approach, scien-tists at the Ontario Cancer Institute of the University Health Network (Toronto) led by the author have developed a revolutionary new hand-held optical imaging device called PRODIGITM, which permits rapid and quantitative detection of pathogenic
bacteria loads in and around wounds using the power of light. This non-invasive (fluorescence) imaging point-of-care technology is in mul-tiple clinical trials and being com-mercialized to help clinicians and nurses to detect infection and bacter-ial biofilms instantly (without drugs or other agents). Image-guidance with PRODIGITM helps accurately target swabs, guide debridement and cleaning and determine the effective-ness of treatments over time and can be used with emerging telemedicine infrastructure in remote locations (e.g. home setting).
Game changersSuch novel technologies, whether used alone or in combination, are game-changers in wound care. Along with regenerative and stem cell therapies, skin substitutes, as well as new and more potent antibacterial therapies, the new frontier of wound
cReAtinG iDeAScare is wide open. While most of the heavy lifting in wound care falls on the shoulders of front-line clinicians and caregivers, there remain unmet clinical needs in wound care diag-nostics, advanced “selective” ther-apies and methods to provide better response monitoring. The future of wound care research must focus on developing and commercializing new evidence-based diagnostic and thera-peutic innovations centered on the individual patient and complement current approaches. The need to heal wounds faster, improve patient out-comes and quality of life and improve cost effectiveness are major driving forces behind the need for technology and practice innovations in wound care management. Indeed, this is an exciting time for wound care.
Dr. Ralph S. Da CostaCancer Care ontario research Chairin Cancer imaging; principal investigatorontario Cancer institute,University Health Network
Diabetes and its effect on wound-healing
pAiD FoR BY ADVeRtiSeRS
1Health Outcomes World-wide (HOW) is a best in class Canadian company
offering innovative outcome measurement eSolutions.
Our clinical expertise and cross-sector experience provides our customers with data, education and tools to build knowledge and develop strategies to improve patient care.
Using our solutions to keep clinical processes aligned with strategic objectives, health care organizations are able to decrease costs, enhance patient safety and improve value in the health care system
2 ForeSite™ is an innovative line of pressure sensing products developed for the
medical market by XSENSOR Tech-nology. ForeSite continuously monitors persistent pressures that are early indicators of decubitus ulcers (or bed sores). With models designed for hospital beds and wheel chairs, ForeSite gives healthcare providers the informa-tion they need to assist in their ongoing efforts to prevent pres-sure ulcers. XSENSOR Technology Corporation of Calgary, Alberta is a leader in the field of pressure imaging with applications in auto-motive testing, sleep research and pressure ulcer prevention.
4KLOX Technologies: advancing biophotonics, the future of chronic
wound healing Using innovation to treat
chronic wounds is a key strategic priority for Canadian company KLOX Technologies. The team in Laval is focused on the global development and commercialisation of a unique, non-invasive biophotonic system that induces a wound healing response in previously unresponsive chronic wounds. Now in the clinical trial phase, its tissue repair program will include pressure sores, diabetic foot and venous ulcers. KLOX Technologies in parallel is advancing proprietary biophotonic programs in dermatology and dentistry
5Meditech International is a medical technology company specializing in
the design, manufacture and dis-tribution of the BioFlex Laser Therapy Systems utilized by healthcare professionals in 48 countries worldwide. Founded in 1989 by Fred Kahn, MD, FRCS(C) and approved by Health Canada, the BioFlex System is an emerging technology that is highly effective in treating an extensive range of medical conditions including wounds, dermatological lesions, sports injuries and arthritis. The patented device targets diseased or injured tissue at the cellular-molecular level
3ScarX Inc., a Toronto based startup company, is developing a therapeutic
cream that dramatically reduces scar formation during wound healing. Scar formation concerns millions of surgery patients each year; estimated $4 billion market in North America alone.
Based on 20 years of research by Dr. Benjamin Alman, Senior Scientist and Head of Orthopaedics at SickKids Hospital, this discovery promises to be the first clinically-proven prescription drug to prevent excessive skin scarring.
ScarX has attracted one million dollars in seed investment and expects to start clinical testing in 2013.
Wound care innovationsMADE IN CANADA
AN iNdepeNdeNt SUppLeMeNt by MediApLANet tO tHe NAtiONAL pOStAN iNdepeNdeNt SUppLeMeNt by MediApLANet tO tHe NAtiONAL pOSt NoV 2012 · 5
It is alarming that despite the wide-spread concern over health expendi-tures and the extensive effort to improve patient safety and health care quality, the Canadian health system is performing at a medi-ocre level when it comes to wound management. The likelihood of a patient acquiring a pressure ulcer in a Canadian hospital is 3-4 times greater than if they were cared for in a hospital in Sweden or Japan. In addition, the majority of home-care nursing visits in Canada are to treat wounds, the majority of these are caused by post-surgical wound infections or poorly managed dia-betic foot ulcers.
Cost of careThe system consequences of being mediocre are significant - higher lengths of stay contributing to hos-pital congestion, higher costs to heal wounds, and increased workload for the care team. However they are also significant for patients who directly experience the pain and inconven-ience of treatments, extended stays in hospitals, loss of health, loss of mobil-ity and in the most serious cases, amputations and complications lead-ing to death.
In organizations in Canada and abroad where wound care has been identified as an important priority, the results are very different than the
average Canadian experience. Hos-pitals, long-term care facilities and homecare programs in Canada with strong evidence-based wound man-agement programs are demonstrating world-class performance.
Moving forwardSo how do we get there nationally? There are several key success factors:
■■ strong direction and support from senior leadership making wound management a priority;
■■ ongoing monitoring and reporting of the incidence and prevalence of pa-tient wounds;
■■ education on evidence-based wound management to all members of
NEWS
leadership: “The Difference Maker”
JOE ROSENGARTEN
RAY RACETTE
anyone diagnosed with diabetes knows the disease impairs their ability to heal and the sim-plest cut or sore can turn serious very
quickly. Diabetes affects the body in several ways – it carries the risk of narrowing the blood vessels in the legs resulting in reduced blood flow to the legs and feet; it impairs the body’s ability to fight infections and delays the wound healing process; and it affects the body’s nerves and their functioning. This leads to a loss of sensation and feeling in their legs and feet and a greater chance that minor cuts or bruises go undetected and can lead to a diabetic foot ulcer.
Cost of diabetesLeft untreated, the tissue will begin to die and ultimately an amputation will be the only option. A recent large study from Sweden of 2,480 patients with diabetic foot ulcers found that certain factors increased the likeli-hood of amputation, including being
male and having had diabetes for longer than 23 years.
Of the 2.3 million Canadians that live with diabetes, 345,000, or 15 per-cent, will develop a diabetic foot ulcer in their life time. In 2008, 621,000 Can-adians with dia-betes reported they suffered some kind of nerve damage. Diabetic foot ulcers cost the Canadian health care system more than $150 million dollars a year. Each year thousands of Can-adians living with diabetes have a limb amputated even though there is strong evidence that suggests that many ulcers that lead to an amputa-tion may be preventable.
Political attentionDiabetic foot ulcers have gotten the attention of the provincial Premiers. In July 2012, the Council of the Fed-eration’s Working Group on Health
Tips for avoiding an amputation
■■ Early detection is important. Health Canada recommends that people liv-ing with diabetes receive a foot care check-up once every three months,
yet 4 in 10 Canadians with diabetes see their doctor less than once a year.
■■ Stopping the smok-ing of tobacco is strong-ly advised. Statistically, a person who smokes, and is over the age of 40, is the most likely of Canadians living with
diabetes to require an amputation as the result of a diabetic foot ulcer. Daily exercise is also encouraged as is the monitoring and control of blood glu-cose levels.
■■ Feet should be washed daily and dried properly, especially between the toes. Redness or blisters should not be ignored; these are small issues that can both lead to a more serious complication.
■■ Owning the right footwear is im-
Innovation recommended that all provincial health ministers adopt the Registered Nurses’ of Ontario’s Best Practice Guideline for Reducing Foot Complications for People with Diabetes.
perative for someone with diabetes: a suitable shoe will protect the feet properly and prevent injury. If there are any changes in the shape of one of the feet, or if one foot starts to look different than the other one, a visit a health care professional is recom-mended.
■■ Seek treatment immediately if you notice any type of ulcer, blister or callus. Remember that timely treat-ment can prevent the condition from worsening.
■■ Education and awareness are key; being fully informed and equipped with the knowledge of how to prevent foot ulcers will lead to fewer amputa-tions.
So if you are living with diabetes or know someone who is, pay your feet a little attention and check them daily. It may save a leg.
Question: What can we do to reduce the number of limb amputations in Canada?
Answer: Coordinating the efforts of Canada’s ministers of health to adopt best practices and educating persons with diabetes and the public about the potentially devastating impact of a diabetic foot ulcer, can preserve countless limbs.
Diabetes and its effect on wound-healing
Prevalence of Diabetic Foot Ulcersas a percentage
Acute Care DFU
Long Term Care DFU
Home Care DFU
14%9%
77%
“rNAo was delighted to contribute its robust expertise to the Working group’s report, by joining as an active mem-ber of the Clinical practice guidelines Working group, alongside the Canadian Nurses Association (CNA) and the Can-adian Medical Association”
“RNAO was delighted to contrib-ute its robust expertise on guideline development and implementation to the Council of the Federation’s work-ing group on health care innovation by joining as an active member of the Clinical Practice Guidelines Working Group, alongside the
Canadian Nurses Association (CNA) and the Canadian Medical Association”, said RNAO CEO Doris Grinspun.
Ray Racettepresident and Ceo,Canadian College of Health Leaders
the care team;■■ appropriate use of dressings and
technologies;■■ organization-wide implementa-
tion of leading practices to ensure con-sistency of care.
With wound management being a $4 billion issue in Canada it is import-ant that leaders and care providers take on the important challenge of improving our performance.
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85% OF ALL AMPUTATIONS
ARE THE RESULTOF A NON-HEALING
FOOT ULCER
2FACT
AN iNdepeNdeNt SUppLeMeNt by MediApLANet tO tHe NAtiONAL pOSt6 · NoV 2012
INSPIraTION
Since 1999, a partner-ship between long-term residential care provider, Revera, and manufacturing company, 3M Health Care, has prospered.
The initiative aims to ensure that long term care residents who require skin or wound care receive the highest levels of care possible. Their award-winning Skin Health Care Program is considered an industry leader.
Joanne Dykeman, VP of Clinical Ser-vices and Quality Care at Revera, feels that her organization has reaped the benefits of the partnership. “3M has helped us to deliver clinical expertise and products to our residents. Having a network of people with shared goals sharing knowledge has really added strength to out levels of care.”
Shared accountabilityDykeman believes that the nature of
FNWoundCareAd-Final-OL.indd 1 12-10-26 12:06 PM
gaining strength through adversityMy battle against pressure ulcersRobb Dunfield was left a ventilator-dependent quadriplegic at the age of 19, the victim of a fall from a third-floor balcony. The obstacles Robb faced seemed insurmount-able: severely limited mobility, dependency on a ventilator, and the certain knowledge that — barely out of his teens — his life would never be the same. Today, he works as a speaker and the Senior Coordinator of the Rick Hansen Foundation Ambassa-dor Program. Robb lives with his wife Sarah and their two twin daughters, Sophia and Emma, in Vancouver.
Like others who sustain an SCI (Spinal cord injury), I have had many pressure ulcer wounds throughout my life as a quadriplegic. When you get older, the skin thins out, making it easier to have one go unnoticed - particularly in bony areas like the ankles and elbows. One pressure ulcer incident I will always remem-ber happened while my wife, Sarah, was 8 months pregnant with our twin daughters. She was transfer-ring me from my bed to my wheel-chair, and being pregnant as she was (not to mention having less strength than usual), she dropped me on the side of my chair, onto the wheel
brake. It hit my upper thigh, but everything looked okay. We didn’t think much of it.
However, most pressure ulcers start their bruising from the inside, and with more pressure, the worse it gets. By the time the skin breaks, signifi-cant damage has been done, making it too large and difficult to remove. Shortly after this incident, I became ill and very thin – no one knew why at the time but we came to learn later on that I had type 2 diabetes. This was a very stressful time for my family with Sarah going through delivery; I could not be there to help her because I was on my death bed.
The doctors realized that I had a pressure ulcer but needed to treat the diabetes first. At this point, the
pressure ulcer had grown to the size of a softball. While waiting for this surgery, I needed to continue to support my family, which had now had grown by two. Meanwhile, I painted when the pain wasn’t too excruciating to help pay the bills, purchase dia-pers, food etc. The day of my surgery finally came, and thankfully, all went well. The surgeons
repaired the pressure ulcer, and slowly, my family and I were able to resume our normal lives.
Throughout this stressful experi-ence, I realized a very important les-son: I am not invincible, and I need to take better care of myself and my health in order to take care of my family.
To those who go through the same process – you are not alone, but it’s okay to go to the experts. With sup-port and motivation, you can get through anything.
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Hollister is a trademark of Hollister Incorporated. Hydrofera Blue is a registered trademark of Hydrofera, LLC. ©2011
ROBB DUNFIELD,
AMBASSADOR pROGRAM
SENIOR COORDINATOR,
RICk HANSEN FOUNDATION
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INSPIraTION NEWS
Working together for a healthier tomorrowS
ince 1999, a partner-ship between long-term residential care provider, Revera, and manufacturing company, 3M Health Care, has prospered.
The initiative aims to ensure that long term care residents who require skin or wound care receive the highest levels of care possible. Their award-winning Skin Health Care Program is considered an industry leader.
Joanne Dykeman, VP of Clinical Ser-vices and Quality Care at Revera, feels that her organization has reaped the benefits of the partnership. “3M has helped us to deliver clinical expertise and products to our residents. Having a network of people with shared goals sharing knowledge has really added strength to out levels of care.”
Shared accountabilityDykeman believes that the nature of
the partnership has made her organ-ization more self-reflective. “Shared accountability keeps standards high. We have introduced clinical perform-ance targets for skin and wound care and we put ourselves under continu-ous evaluation. We are obligated to do this to prove to our residents that we provide the best health care and value for money.”
The skin of elderly people is often fragile and prone to ulcers and wounds. It is essential that elderly patients receive a consistently high level of skin care because this can be the preventative measure that stops small skin problems becoming more serious wounds.
Together Revera and 3M have introduced best practice guidelines and protocols to ensure that their nurses and clinicians are equipped with the most up-to-date knowledge and training.
Dawn Beaubien, Business Manager
of the Skin and Wound Division at 3M, said: “We at 3M have a large team of clinical experts who understand the challenges that come with caring for long term residents. The success of the partnership is based on collab-oration: we understand the needs of Revera and we are able to offer them our expertise.”
Innovation drivenBeaubien explained that the partner-ship strives towards innovation: “We use their expertise to innovate upon our methods. The partnership has really given us the methods to under-stand the patients’ needs; it helps us to develop the highest quality of skin care products.”
Joanne Dykeman is certain that having a highly informed partner in such a challenging industry is price-less: “Having another set of eyes in the health space helps to keep us up-to-date. When a government
NADINE HENNINGSEN,
ExECUTIvE DIRECTOR,
CANADIAN HOME CARE ASSOCIATION
JOE ROSENGARTEN
Evidence-based wound careThe home care perspective
as the number of indi-viduals receiving home care continues to rise, the appropri-ate management of wounds in the home setting is becoming
critically important, not only because of the magnitude but because of the clinical need. Early discharge from hospital is driving the increase in sur-gical wounds in the home setting as well as the increased need for chronic wound management associated with aging and chronic disease.
Fiscal responsibility Today, more than 80 per cent of ongoing management of chronic wounds, such as leg wounds and ulcers, occurs in the community. Management of wounds for indi-viduals with multiple conditions is
not only difficult for individuals, but is costly to the financially strapped health system. The cost of home care for individuals with leg ulcers (venous stasis ulcers), in Canada, is estimated to be more than $100 million per year (Graham et al. 2003).
Significant savings can be real-ized through the implementation of evidence-based wound care protocols, stated Nadine Henningsen, Execu-tive Director, Canadian Home Care Association. “The need to implement cost effective wound care practices in home care has become a priority.”
Efficient careThrough the adoption of technology, increased access to wound therapies and products, continuing educa-tion and collaboration and outcome measurement strategies, home care programs can promote greater con-
sistency, reduced cost and improved clinical outcomes and quality of life for home care clients with wounds. The Canadian Home Care Association (CHCA) and groups such as the Wound Care Alliance, are working together to advance best practices in wound care. To support this work, the CHCA is releasing a paper to highlight some of these evidence, challenges and opportunities to enhance wound care management within home care. The CHCA is committed to working with governments, administrators, clin-icians, educators and quality councils to positively impact this critical area of health care.
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Joanne Dykeman, RN MA CHE (c)Vice presidentClinical Services and Quality
Dawn BeaubienBusiness ManagerSkin and Wound Care division3M Health Care
agency changes rules or regulations 3M inform us right away. There are so many layers of knowledgeable people and the relationship between us is one of openness and trust.”
Striving for moreDykeman explains how Revera and
3M are not content to rest on their laurels: “In the future we want to redesign systems and streamline our methods. We want to use technology to integrate with our industry part-ners. We are not scared to say that we are learning, that we are on a journey.”
This partnership works because both parties are working toward the same shared goal. The result is a posi-tive outcome for the Revera residents who receive the highest levels of care possible. Beaubien states it suc-cinctly: “We help Revera to help their patients.”
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canada’s medical technology community provides leadershipMEDEC, the national association for the Canadian medical technology industry, has a goal to advance health outcomes for patients in Canada and grow a vibrant technology industry in Canada.
Brian Lewis, MEDEC’s President & CEO, comments that “MEDEC’s regional, functional, and industry
sector committees bring members together to address common issues and support industry initiatives with patient focus. The Wound Care Com-mittee, as an example, is aware that in Canada hundreds of thousands of patients experience the debilitating effects of acute and chronic wounds every day. In a collaborative effort
aimed at supporting a Wound Man-agement Innovation Agenda, the industry under MEDEC’s umbrella, teamed up with a number of clinical stakeholders – the Canadian Associa-tion for Enterostomal Therapy (CAET), the Canadian Association for Wound Care (CAWC), and the Ontario Wound-care Interest Group (OntWIG) – to
pursue the development of a national wound management innovation strategy.”
Brian LewisMedeC’s president & Ceo
kLAUS STITz
vp REGULATORY AFFAIRS, MEDEC
Pressure ulcersTheir devastating yet preventable impact on canadians with spinal cord injuriesSpinal cord injury (SCI) care costs our health system approximately $2.7 bil-lion annually. As the population ages, the number of injured, and the related care costs will grow. Currently more than 86,000 Canadians live with a SCI, and this year alone another 4,300 will suffer a SCI. Sadly most will be young men between the ages of 16 and 34. Adding to the trauma of a SCI, up to 30% of these individuals will suffer a pressure ulcer as a second-ary complication. These most insidi-ous and difficult wounds to heal can seriously interfere with the physical, psychological and social well-being and impact overall quality of life. If left untreated, they can be fatal - as demonstrated by the death of actor Christopher Reeve.
Pressure sores, said Bill Barrable, CEO, Rick Hansen Institute, are the No. 1 preventable complication in the health system. Pressure ulcer preven-
tion and management represents an important aspect of the “cure” for disability associated with secondary complications of SCI and many other diseases such as diabetes, stroke, etc.
The Spinal Cord Injury Knowledge Mobilization NetworkThe Rick Hansen Institute, in col-laboration with the Ontario Neuro-trauma Foundation (ONF) and the Alberta Paraplegic Foundation (APF), are supporting the development of the SCI knowledge mobilization net-work (SCI KMN) that is focused on best practice implementation (BPI) of risk assessment and education for pres-sure ulcers. The result of this work will ensure best practices are standard-ized across Canada and that will result in the reduction of the incidence and prevalence of pressure ulcers.
The Network’s Executive Director, Jane Hsieh said that being able to avoid a pressure ulcer in individuals
with chronic SCI have high impact on activities of daily living and, therefore, quality of life.
The SCI KMN has evolved in paral-lel with other research (also RHI and ONF funded) by utilizing the SCI Pres-sure Ulcer Clinical Practice Guidelines work led by Dr. Pamela Houghton (University of Western Ontario) and the network includes other experts including Dr. Chester Ho (Foothills Medical Centre); Dr. David Keast (St. Joseph’s Health Care in London) and Dr. Karen Campbell (University of Western Ontario), just to name a few.
Under ONF leadership, this work has resulted in BPI at 6 Canadian rehabilitation centres. The intent is to share this work with sites not cur-rently participating in SCI KMN.
Best practice toolsWhat is particularly exciting is that the principles and tools used by the SCI KMN are transferable to not only other types of clinical practices, but
coLLectiVe DiScoVeRY
Bill Barrable,Ceo rick Hansen institute
of Ontario and highlighted in last summer’s Report from the Council of the Federation’s Working Group on Health Innovation.
The work of the SCI KMN paves the way towards a “cure” for disability resulting from the ongoing issue of rising wound incidence and preva-lence. This form of “cure”, in the guise of pressure ulcer prevention and management through BPI, has been made possible through the leader-ship of champions like Rick Hansen. RHI, ONF and APF are galvanizing with like-minded groups to continue to lead the way to improving health outcomes through best practices in patient care. For more information contact Jane Hsieh at [email protected] to other diseases and disciplines.
This may be of interest to the prov-incial Ministers of Health who were directed to adopt and deploy within 24 months the best practice guidelines for diabetic foot ulcers developed by the Registered Nurses’ Association
pHALGUN JOSHI, pH.D.
MANAGING DIRECTOR,
TRANSLATIONAL RESEARCH pROGRAM
RICk HANSEN INSTITUTE
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