Canadian patients suffering, sometimes dying, with bedsores
It allegedly began as a minor abrasion at Chrissy Dunnington’s tailbone.
Her family says that by the time they saw the wound, Dunnington had been transferred from a Halifax nursing home to a hospital ER – and it had become a horrifying fist-sized hole that they believe is linked to her death.
“It was as deep as her spine,” her sister Dorothy Dunnington said of what she saw when a doctor at the Queen Elizabeth II Health Sciences Centre removed a bandage in January 2018.
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“We were all shocked and there were a lot of tears. Our parents, thankfully, had gone home at that time so my mother did not see it that day. We were able to prepare her first before she saw it.”
Bedsores – also known as pressure ulcers – have garnered recent attention in Canada with other cases including the death last month of a 77-year-old man at a hospital in Burlington, Ont., that the family alleges was related to a bedsore.
The deaths put a spotlight on what a wound-care specialist said often involves lack of preventative care by untrained health-care providers despite the country’s international reputation for developing highly successful educational programs.
Tracy Johnson, director of emerging issues at the Canadian Institute for Health Information (CIHI), said 3,246 people were diagnosed with bedsores at hospitals across the country in 2016-2017, compared with 3,023 patients two years earlier. (Manitoba, Nova Scotia, Newfoundland and Labrador report only partial data and several other jurisdictions including Quebec report no data.)
Dr. Morty Eisenberg, a wound care specialist at St. John’s Rehab hospital in Toronto, said bedsores in their early stages are not always charted by doctors or nurses so it’s hard to know the full extent of the problem.
He said the last large study in Canada, published in 2004 and involving data gathered between 1990 and 2003 from 41 hospitals and long-term care homes, showed 26 per cent of patients had bedsores, but new studies are needed to gauge the extent of the current problem.
“I would be surprised if there’s any significant improvement,” Eisenberg said, calling the issue an “uphill battle” due to an aging population that is more susceptible to pressure ulcers and the lack of wound-care education of health-care professionals.
“How is it going to get better? It’s not going to be administration. It’s going to be the public that has to stand up and say, ‘Do something.’ It’s the government that holds the purse strings.”
Chrissy Dunnington, 40, died in March 2018, seven weeks after being admitted to hospital. Her family filed a police report, claiming lack of proper care by the Parkstone Enhanced Care facility amounted to a crime. Dorothy Dunnington said a doctor at the hospital told the family her sister died of sepsis from a Stage 4 pressure ulcer.
“We strongly disagree with the characterization of this as a crime,” said a statement from Shannex Inc., which owns and operates Parkstone, along with 21 other facilities in Nova Scotia and New Brunswick. “We have been fully transparent with the police.”
Chrissy Dunnington is seen enjoying a popsicle in hospital in a December 2017 family handout photo. Chrissy Dunnington, 40, died in March 2017, seven weeks after being admitted to hospital.
Const. John MacLeod of Halifax Regional Police said in a statement an investigation is ongoing as the department awaits the medical examiner’s ruling on the cause of death. The service would not comment further while the investigation is underway.
“We understand how difficult this situation has been for the family, but also for our staff as they have shared how much they truly cared for Chrissy,” said Shannex spokesman Matt Proctor. The facility would not comment on the cause of death.
The case appeared to have an immediate impact on Nova Scotia’s approach on bedsores.
A year ago, the Nova Scotia government began requiring long-term care facilities to report new cases of pressure ulcers, and the Department of Health and Wellness said data from the first quarter of that period will be posted online later this month.
Bedsores are caused by sustained pressure on certain parts of the body – typically at the tailbone, hips or heels – among some patients who are unable to move because of physical limitations or if they’ve been sedated with medication.
In the Burlington, Ont., case, Joseph Brant Hospital released a statement in May saying it had launched a review to improve wound care after the family of 77-year-old Bob Wilson went public about his bedsore, which like Dunnington’s, had become infected. Wilson died in June.
“We are very sorry any time a patient experiences harm in hospital,” president Eric Vandewall said in the statement. “We are taking immediate action to address these issues more broadly.”
The cause of Wilson’s death has not yet been confirmed, and the coroner is investigating.
A spokesman for the facility said a report on the review was expected to be completed this month and the facility will give the family an opportunity to view the findings.
Eisenberg said the vast majority of bedsores are preventable, except for a small percentage among palliative-care patients whose organs, including their skin, start to fail, but health-care staff often don’t know how to identify and treat them.
The worst bedsores, classified as Stage 4, expose bone, muscle or tendons beneath broken skin, he said.
“They’re not that uncommon,” Eisenberg said, adding the festering wounds can have a foul smell, which Dunnington said was the case for her sister as evidenced by the odour in the emergency room when the bandage was removed.
“We’ve been trying to make progress on this for many, many years,” Eisenberg said of efforts to educate health-care professionals to prevent and manage bedsores with multiple educational programs offered in Canada.
Wound care involves a team of health-care professionals including nurses, occupational therapists, physiotherapists and pharmacists who may have to change sedating medication so patients are alert enough to move, said Eisenberg, who is president of Wounds Canada, which provides online treatment modules, workshops at conferences and at various hospitals.
The University of Toronto’s faculty of medicine offers a one-year advanced wound-care program that draws Canadian and international professionals to two four-day residential sessions, one in the fall and another in late spring, with online work in between, Eisenberg said.
“We have taken that program all over the world. Toronto is a real hotbed in experts in wound care. We’ve developed this program. We teach it every year in South Africa. We’ve taught it in Dubai. I’ve personally taught it in Saudi Arabia. It’s been taught in Tehran.”
A full-time one-year masters program is also available through the university as well as Western University in London, Ont., Eisenberg said, adding health-care workers who take any of the programs have to be replaced and that can be a challenge for budget-strapped facilities, though the health-care system ends up paying higher costs when bedsores progress to severe levels.
“When hospitals are overcrowded, patients may lay in the emergency room for three days before they even make it onto a floor. They’re laying on these stretchers and many times injuries may develop there, within a very short time.”
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