Expert says pressure injuries such as bedsores are preventable

While police investigate the circumstances surrounding the death of Chrissy Dunnington at a long-term care facility in Halifax, expert Corrine McIsaac says the type of sores she had on her body are preventable.

On Jan. 22, Dunnington's family received a call to say Chrissy had a fever. The next day staff said they thought she had an infection related to a bedsore that had first been noticed in October.

McIsaac, a registered nurse with a doctorate in wound care, has been focused on pressure injuries for 20 years. She prefers the term pressure injury to bedsore to describe this type of sore.

Group tried to bring more attention to issue

McIsaac said The National Pressure Ulcer Advisory Panel, an independent organization dedicated to the prevention and management of pressure injuries, changed the wording from bedsores to pressure injuries last year. She said the reason for the change was to draw attention to the issue.

"'Bedsores' really doesn't encompass everything we mean by these problems we're seeing in long-term care, home care and community care," she said. "They're very prevalent. They can be very large and very problematic."

She said that many pressure injuries are preventable by modifying certain factors such as turning, positioning and nutrition. She said the same might not be true in a seriously ill patient.

"It's probably 95 per cent of the time pressure injuries are preventable," she said.

Provincial bedsore tracking

On Wednesday, Nova Scotia Health Minister Randy Delorey announced his department would begin tracking incidences of bedsores at long-term care facilities across the province.

The department is requiring long-term care homes to immediately report all pressure wounds and will require all stage 3 and 4 pressure ulcers be reported to the department from now on.

The province is now establishing wound-treatment protocols. Until now, facilities could develop such protocols on their own.

In the meantime, the department is issuing a one-time order that requires all facilities to immediately report all bedsores, regardless of severity.

McIsaac said she thinks a one-time order to report all bedsores is an inefficient way of dealing with the problem. She said this type of reporting needs to be standardized and should be done on a monthly, or even weekly, basis.

Too late?

"Stage 1 pressure injuries are where we really need to get to [in order to] make a difference in this problem. It's important to report Stage 3 and 4, but quite frankly— it's almost too late then," she said.

She said if nurses and physicians could be equipped with the right technology that could make this job easier for them, the identification of Stage 1 pressure ulcers would prevent events similar to those in Dunnington's case.

She said if staff had the right tools to help them do their jobs more efficiently, less staff might be required. "We need to be more efficient and we need to be more focused on outcomes instead of just delivering a service."

Criminal negligence

Police will try to determine if Dunnington's death resulted from criminal negligence.

Andrew Barbacki, a criminal defence lawyer for more than 40 years and a former Crown prosecutor, said that criminal negligence  "shows a wanton and reckless disregard for the lives and safety of others."

He said: "It is an extreme form of negligence, criminal negligence is the highest form of negligence. It's what they used to call 'advertent negligence.' In other words, you know of the danger but you go ahead and take the risk."

McIsaac said that she has heard of a pressure injury leading to a criminal negligence investigation before. She said about once a month she is being asked to be an expert witness in these cases.

"I think we have to take this issue very, very seriously, and we have the expertise in the province to really, really come together and do something wonderful for the residents of Nova Scotia."