It’s an epidemic. And few people outside of the health care industry know anything about it. Wounds cost the Canadian health care system $3.9 billion annually—an astonishing statistic.
Some of the most costly wounds are chronic, meaning they don’t heal in regular stages over a predictable period of time. But health care dollars aren’t the only concern. All too often, patients with chronic wounds struggle with pain, a compromised quality of life, and shame.
Often, these symptoms and negative feelings can be alleviated by at-home care. But nurses who provide wound care in patient homes face significant challenges. Without the support available in acute care settings, these clinicians can’t always provide the high-quality treatment that patients need.
The good news is, there’s a solution to some of the health care system’s biggest wound-related challenges. And it all begins with wound care nurses.
A Hidden Epidemic
Many people have heard of wound-related complications during times of war. Far fewer are aware that outcomes such as gangrene and amputation can result from poorly-managed diabetes.
Nurses know. For clinicians who treat patients with chronic wounds, fighting off infection is crucial. The consequences of an inaccurate assessment or improperly-dressed wound can be devastating. And unfortunately, less-than-optimal wound care isn’t uncommon in patients’ homes.
A Canadian Institute for Health Information (CIHI) study found that compromised wounds occurred in 7% of home care patients. For acute care, the number was significantly lower at 4%. The CIHI study focused on preventable compromised wounds.
The takeaway is clear. When it comes to wound care, there’s room for improvement—especially in the home care sector. And the time to take action is now. Public rallying cries for better wound care occur rarely, if ever. But if you’re a nurse, you know just how critical this often-overlooked issue is.
According to nursing professor Corinne McIssac, wound care may be responsible for up to 50% of care delivered in patient homes. And it’s no small number of patients using these hours. One-third of home care recipients have wound care needs.
As the population ages and rates of diabetes rise, this number is likely to continue growing. Unless things change, costs will get out of control. Worse yet, a very large segment of the population will undergo suffering, discomfort, and limited mobility. Because chronic wounds are rarely talked about, many will do so in silence.
So why isn’t wound care in Ontario—and across Canada—as good as it could possibly be? Why are there more compromised wounds in home care patients? And what can we do to make things better?
A Better Way to Care for Chronic Wounds
Ontario’s wound care challenges are nothing new. A 2010 Toronto Star article explored some of the major ways the province could improve its treatment of wounds. Insufficient coordination was identified as one of the biggest issues impacting care quality.
When several community agencies contribute to a patient’s home care services, wires can get crossed. Problems ensue—especially when providers don’t communicate well. Clinician time and health care dollars are wasted, and (in many cases) patients suffer needlessly.
Luckily, the Ontario government has made great strides toward providing better-coordinated care at home. The Ministry of Health and Long Term Care has publicly recognized the need to streamline service delivery. By investing in initiatives like Health Links, the province is making it a priority for regional providers to work together. This shift represents a major improvement across patient service areas—including those related to wound care.
Another major problem has to do with the scarcity of expertise in the field. Currently, the demand for wound care specialists far outstrips the supply. This problem is particularly pronounced in home care. It’s not unusual for a handful of enterostomal therapy (ENT) nurses to cover a large geographical area.
Paraphrasing Dr Brian Golden, the Star article highlights the fact that many of the nurses involved in home wound care are “generalists”, as opposed to specialists.
The good news is, there are ways to make the most of existing wound care expertise. Ongoing collaboration between generalist home care nurses and ENT nurses is the key. While coordination is improving, nurse partnerships will work better when more practitioners access resources to communicate on the job.
Towards a Better Wound Care Future
There are only so many wound care specialists in country. Despite their devotion, experts who make home visits can’t see nearly as many patients as they’d like. The answer is simple. Whenever possible, generalist nurses need to apply the knowledge of wound care specialists.
Education is crucial. Many clinicians see the gap between wound care best practices and the treatment that’s actually provided in patient homes. The truth is, while nurses want to provide their patients with the best care possible, they don’t always have the training to do so.
Practice Support Nurse Kerstin Lewis recognizes the problem in British Columbia, where she works to improve evidence-based wound care at home. Lewis has formed working groups in order to figure out what, exactly, home care nurses need to know about wounds. She’s compiled what she’s learned into a set of online resources.
While best practices and general knowledge are important, Lewis notes that there are “very few absolutes in wound and skin care”. The truth is, in many cases, there’s just no substitute for a specialist’s experience.
Telehealth technology can help. By connecting home care nurses with ENT specialists, digital communication tools can provide practical on-the-job training. With the right videoconferencing app, nurses can receive coaching from their laptops or mobile devices.
It’s an obvious win-win-win. Generalist nurses get to build their wound care skills and capacity. Specialists get to help more people who are living with wounds. And of course, patients receive the benefits of a home visit from an expert.
In addition to providing new learning opportunities, digital solutions can enable the secure exchange of health information. Videos, pictures, and mobile text—sharing sensitive data has never been safer.
Wound care specialists need these materials in order to provide timely and accurate patient feedback. Generalist nurses, in turn, often require real-time feedback in order to provide the care that patients need,
Digital technology is opening up a whole new world of possibilities in wound care. To make decisions that benefit their patients, nurses and provider organizations will have to do their homework.
The Bottom Line
Many Canadians are blissfully unaware of the problems associated with chronic wounds. But as the epidemic grows, few will be untouched by the pain they can cause. Today, anyone with a diabetic loved one should see the value of high-quality wound care.
Raising awareness is key. And in the medical community, nurses are leading the charge. Luckily, there are plenty of digital tools available to improve long-distance treatment, communication, and education. The future looks bright for nurses, specialists, and those who will develop chronic wounds in the years ahead.
Feature image courtesy of Becky Stern
