Joseph Brant Hospital Releases Expert Review of Pressure Ulcer Protocols and Action Plan

July 19, 2019

Joseph Brant Hospital Releases Expert Review of Pressure Ulcer Protocols and Action Plan

Improvements made by JBH can deliver “Gold standard care,” expert says

In keeping with its commitment to the community as part of its Pressure Ulcer Action Plan, Joseph Brant Hospital (JBH) today released the public report of the independent expert review conducted by leading authority Dr. R. Gary Sibbald.

Dr. Sibbald is an authoritative expert in wound care – which includes the identification, care and treatment of pressure ulcers, often commonly referred to as bedsores. He is a Professor of Medicine and Public Health at the University of Toronto and an international wound care key opinion leader (educator, clinician and clinical researcher). He is also a member of the active staff of Women’s College Hospital and Trillium Health Partners, co-founder of the Canadian Association of Wound Care, and was the former Director of the Wound Healing Clinic, Women’s College Hospital. Dr. Sibbald is an associate Clinical Editor for the Advances Skin and Wound Care journal. He has over 200 publications and is co-editor and chapter author of the Chronic Wound Care 5 textbook.

For the purpose of this review, Dr. Sibbald’s mandate was to review the hospital’s policies and procedures regarding the prevention, diagnosis and treatment of pressure injuries. In addition, he was asked to review relevant clinical information, the recommendations arising from the internal reviews that were conducted by JBH, and JBH’s Pressure Ulcer Action Plan.

Following are key excerpts from Dr. Sibbald’s report:

On JBH’s handling of pressure ulcers

• “Joseph Brant Hospital has identified system-wide challenges and opportunities to provide leading practice wound care and optimize the management of pressure injuries.”
• “Joseph Brant Hospital has conducted comprehensive quality of care reviews and analyses. With the ongoing development and deployment of system aids to patient care, patients with similar problems can be treated with gold standard care.”
• “I am satisfied with Joseph Brant Hospital’s documentation, review processes and proposed next steps. Joseph Brant Hospital’s policies, procedures and processes are consistent with current best practice guidelines. I believe that the recommendations arising from the internal reviews and the associated action plan are thorough.”

On JBH’s public reporting on pressure ulcers

• “The recent prevalence and incidence study conducted by Joseph Brant Hospital on May 24, 2019, revealed a prevalence rate of pressure injuries of 7.6%, well below the national average of 15.4%.”
• “The incidence rates for hospital acquired pressure injuries was 4.1%, also less than the national average of 6.3%. This data is consistent with the results from February of each year from 2016 – 2019, which demonstrate pressure injury prevalence and incidence well below the national average at JBH.”

On pressure ulcers in all hospitals

Dr. Sibbald noted that not all pressure ulcers develop in hospital – patients may present with preexisting or already developing pressure ulcers. His report describes the differences between “healable” and “non-healable” pressure ulcers, and that this is often determined by patient-specific clinical circumstances – especially for those receiving palliative care at the end of life:

• “Not all pressure injuries are preventable and not all pressure injuries have the ability to heal.”
• “Unavoidable skin breakdown is often associated with other organ failure as the general health of the patient deteriorates.”
• “It is important to understand skin breakdown at the end of life and the need for care plans based on patients’ and their circle of care goals. There needs to be communication with families clarifying that, as the body fails, so does the skin. In patients with severe underlying illnesses and accompanying skin failure, there should be a clear emphasis on total patient care (physical and emotional), providing quality of life, pain relief and family support.”

Recommended enhancements to existing protocols and practices (for JBH and all hospitals)

1. Development of user-friendly wound care assessment tools that will facilitate interprofessional communication.
2. Enhance the collaborative care provided by the interprofessional team coordinated with wound specialist(s), wound champions or link nurses on each unit, and other health care team members.
3. Provide advanced education for this specific group of professionals to work with the skin and wound Clinical Nurse Specialist to create an expert team that includes physicians, allied health and the unit nurse wound champions.
4. Use photography in a structured way to follow wound progress and integrate these photographs in the shared health record (where feasible). Consider software that will facilitate wound measurements.
5. Recognize the need for coordination of care across the continuum by creating partnerships with community physicians, home and community care, and other community and institution providers involved in wound/skin care.
6. Undertake quality improvement exercises to ensure a successful implementation plan over a projected two-year period.
7. Continue the practice of conducting enhanced prevalence and incidence surveys to help track progress and measure Joseph Brant Hospital’s performance against peer organizations.

“We thank Dr. Sibbald for this comprehensive, expert review of both our long-standing procedures for identifying and treating pressure ulcers and the processes that we have implemented as part of our Pressure Ulcer Action Plan,” said Eric Vandewall, President and CEO of Joseph Brant Hospital.

“We’re pleased by Dr. Sibbald’s endorsement of our existing practices, and we will move forward to implement his recommendations in order to enhance the care that we provide. JBH will continue to strive to be a leading hospital in all areas of care, including pressure ulcers, which Dr. Sibbald notes present a challenge not just for our hospital but for hospitals and care facilities everywhere,” said Dr. Ian Preyra, JBH Chief of Staff.

“We’re also pleased with his statement that he was satisfied with our documented review and with our Pressure Ulcer Action Plan,” adds Preyra. “We acknowledge the regrettable errors in communication, and can assure the community that through the steps we have already taken – and with Dr. Sibbald’s recommendations – that JBH will deliver the ‘gold standard care’ he believes is possible.”

Attachments

Media Release: Joseph Brant Hospital Releases Expert Review of Pressure Ulcer Protocols and Action Plan

Report of External Review Issue Management - Pressure Injury