Bedsores seriously under-reported, health-care experts say

Bedsores have become a serious issue, but no one knows exactly how big the problem is in Nova Scotia, or even in Canada.

The provincial department of health is currently investigating four cases of patients with severe bedsores acquired in hospitals or long-term care homes.

Halifax police are also investigating after​ Chrissy Dunnington died in March with a fist-sized open wound she got while in care.

Bedsores seriously under-reported

Health-care experts have said the numbers on bedsores are seriously under-reported — and recent figures illustrate how little is known about the size and depth of the problem.

Nova Scotia Health Minister Randy Delorey demanded a snapshot count in June. It found 152 patients in long-term care care with severe bedsores on one day.

And the health department's serious reportable events website showed seven bedsores were acquired in acute-care hospitals in the most recent three-month period.

Despite those numbers, Delorey said he has a handle on the problem.

Determining scope of problem

Along with the snapshot count, Delorey has asked for ongoing counts of the worst bedsores, known as Stage 3 and Stage 4 pressure ulcers.

"I think we're doing the right things, because step one, we're collecting the data to identify information we never had, which is the size and the scope of the number of injuries, and locations," the minister said in a recent interview.

Tracy Johnson, director of health systems analysis and emerging issues with the Canadian Institute for Health Information, said few provinces have reliable data on bedsores — and that means there's no good national data.

Some provinces are better than others at reporting bedsore rates, she said. Many have partial data from hospitals and long-term care homes, and fewer still, like Nova Scotia, have any data at all from home-care settings.

Despite the fact that the Nova Scotia Health Authority says its prevalence rates are going down and are better than the national average, Johnson says there's actually no solid information on what the national average is.

N.S. numbers based on tiny sample size

In fact, Nova Scotia has only been able to supply the national health data agency with long-term care home numbers from Seaview Manor in Glace Bay. That means that any numbers representing the province's long-term care home bedsore rates are based on a tiny sample size.

"We have more complete long-term care [data] in British Columbia and Alberta and Ontario, and we have pockets elsewhere," Johnson said. "In Nova Scotia, we have long-term care data for one institution."

Part of the difficulty is that there are no standard ways to collect data on bedsores. Treatments might be recorded in doctors' orders or in nurses' notes.

"Provinces are quite interested in safety, and so are hospitals," said Johnson. "Pressure ulcers are one of those things that people would like to be more certain on the data quality.

"Most people would tell you that they're uncertain about the quality of the data for pressure ulcers. So more work needs to be done on that."

Mandatory reporting worst bedsores

Until recently, Nova Scotia's health department recorded total bedsore numbers while the health authority reported prevalence rates, which are calculated by the total number of patients in care divided by the number who have bedsores.

Delorey said since June, the standard has become total numbers, and historical data don't matter, because the goal is to treat existing patients properly.

"I don't see that as being a problem, because at the end of the day, from a care perspective, it's knowing how many incidents that exist," he said.

At the same time, the province changed its reporting requirements, making it mandatory for facilities to regularly report the worst bedsores.

That will help officials establish standard protocols for prevention and treatment, said Delorey.

"It is the first time that we've collected it in this way, so we're going to continue to learn from this information and improve both the data collection and reporting of information as we continue to learn from the information that's out there," he said.

"The information certainly helps us in what our first priority is, which is the care and the treatment provided to residents."

Bedsore policies and procedures

The department does not have any policies and procedures around bedsore prevention or treatment, but the health authority does.

But Delorey said the province needs to come up with standards applicable in hospitals, long-term care homes and in home care.

Those standards are being developed, but there's no timeline for when they will be ready, he said.

"Our first priority is the care and services being provided to our residents that are in our facilities right now," Delorey said.

"We know from our preliminary data where the highest prevalence rates [are] and what facilities have residents with pressure injuries in various stages, so we've been out there reassessing and providing those supports and resources to those facilities to ensure those residents are getting the care that they need and that their injuries are being treated appropriately."

Pilot project

The health department awarded a tender two years ago to Health Outcomes Worldwide, a New Waterford firm, to establish a provincewide wound care program, but government officials say it's only in the "early stages" of a pilot project.

The company's software, which manages and monitors treatment, is being tested in Cape Breton in home-care settings.

Delorey said even though there is no data on bedsores in home care, the pilot project makes sense.

"When doing a pilot project, you're collecting the data along with treatments that are being provided," he said.

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