Q&A

Halifax long-term care facility boasts one of the lowest bedsore rates in the country

A Northwood wound care manager says the Halifax facility switched its focus from treatment to prevention and reduced its bedsore prevalence rate from 12 per cent to 1.9.

Northwood switched focus from treatment to prevention

Bernadette Mitchell-MacDonald says Northwood has reduced bedsore prevalence with a risk assessment tool and prevention products. (Elizabeth Chiu/CBC)

Prevention is key when it comes to bedsores.

That's how one long-term care facility in Halifax said it reduced the bedsore prevalence rate from 12 per cent to 1.9 per cent in six years.

The wound care team at Northwood changed its focus from treating pressure injuries, commonly known as bedsores, to preventing them with a risk-assessment tool, monitoring and the use of a range of prevention products.

As of last week, padded booties, wedges, transfer bedsheets and padding for chairs are available to all long-term care facilities through the provincial formulary, said Bernadette Mitchell-MacDonald, who leads the wound care program at Northwood.

In June, the Health Department revealed there are 152 cases of severe bedsores across the province.

Police are investigating the death of long-term care resident Chrissy Dunnington, a woman whose family said she suffered from a "horrific" case.

CBC News interviewed Northwood's Mitchell-MacDonald. The interview has been edited for length and clarity.

I understand Northwood has a pretty impressive track record when it comes to bedsores.

Our current pressure injury prevalence is at 1.9 per cent. I'm very proud of that, I'm very proud of our staff. Six years ago, our prevalence rate was 12 per cent.

What does that actually mean in real numbers?

It means that we have out of 485 residents living in Northwood, we have six residents that have been identified with stage 3 and 4 pressure injuries. Of those residents with pressure injuries, most of them have to come to us from another facility. Of the six residents, one of them was a facility-acquired injury, which we also track as part of our risk assessment and prevention.

How does that compare to the national average?

The national average is around 10 or 13 per cent, so it's pretty low compared to what the national standards are currently.

That means that 10 to 13 per cent of long-term care residents in Canada have a pressure injury?

Correct.

That's a high number. You've been able to bring it down quite dramatically. How have you been able to do that?

Two years ago, we focused more on prevention. We have an interprofessional wound care team. And we changed our focus from 'What products are we going to use to treat the wounds?' to 'What are we going to do to prevent the injury from occurring?'

So, we put different things in place. We have a risk-assessment tool. Depending on how the resident scores, if they are at risk, we put interventions in place.

And the team actually listed out all the interventions. So, if someone scores at-risk, or even low-risk, we have things that we put in place to prevent pressure injuries from occurring.

And what are these things here that help?

One of the things we have is booties. This would go on a resident's heel. This helps prevent pressure injuries on a resident's heel.

Padded booties can help prevent sores on patients' heels. (Elizabeth Chiu/CBC)

We have wedges, and this helps keep a resident on their side so they don't roll back on the pressure injury on their bottom.

Wedges keep patients on their sides to keep the pressure off of bedsores. (Elizabeth Chiu/CBC)

We have transfer sheets. This is like parachute material and this helps move the resident up and down in bed, so they don't sustain any friction when they're moving in bed.

So movement is very important to prevent pressure injuries.

Yes, how we move them and how often they're turned is very important to prevent pressure injuries from occurring.

And how often are we talking about?

The standard is around every two hours. We try to maintain that. But some residents that we identified at high risk, it might be every half hour, it might be every hour. It depends. Each resident is an individual and based on what's going on it might be more frequently.

Bubble-like padding helps relieve pressure on bedsores. (Elizabeth Chiu/CBC)

We've heard unions say that what's key to preventing pressure injuries is having more nurses on staff, on duty. What do you say to that?

I think having more nurses would be wonderful to have on staff. But we've been able to reduce our pressure injury prevalence to 1.9 per cent, so if we had more nurses, maybe we'd be at zero per cent, which would be a wonderful story to tell you.

The message I'm getting from you today is prevention is key, and risk assessment.

Prevention, risk assessment and I think the bigger message with all of this is education. You can't do any of this unless the staff are well educated on to how to prevent, what wounds are, factors that influence wound healing. There's all kinds of things. Wound healing is very complex. It's not just a simple bedsore.

Read more articles from CBC Nova Scotia