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Better reporting cited for bed sore increase

Nova Scotia Health Authority
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A recent spike in the number of patients suffering from serious bed sores acquired in Nova Scotia hospitals — something health officials say should never happen in hospitals — is a result of increased reporting, according to the Health Department.

According to the department’s serious reportable events website last fall, the number of stage 3 or 4 pressure ulcers, also known as bed sores, averaged about 12 incidents every quarter over the previous 30 months.

In the past three months, the department recorded 20 incidents.

Such bed sores are considered serious and can lead to infection, amputation and possibly death, yet are considered by health officials across Canada to be almost entirely preventable.

Late last year, an expert in wound care told The Chronicle Herald that Nova Scotia hospital patients are suffering, and in at least one case dying, from a lack of proper attention to pressure ulcers.

At the time, Corrine McIsaac said the numbers were likely under-reported, and the province now says a recent third-quarter study has improved the reporting.

The Nova Scotia Health Authority “conducted a pressure ulcer study during Q3, as it has done in each of the last two years, which has resulted in higher pressure ulcer reporting,” Health Department spokeswoman Natasha Halili-Banks said in an email Thursday.

“It is part of a provincial wound care committee looking at standard guidelines and best practices to develop a staff education plan. After the first study, NSHA developed and implemented an organization-wide pressure ulcer prevention policy.”

Several of the patient harm events listed on the serious reportable events website — including such things as surgery on wrong body parts, death or disability due to medical issues, and patients suffering from serious pressure ulcers — are considered to be “never events” by the Canadian Patient Safety Institute.

That is, they should never happen in hospitals.

Canada seems to be doing well compared to some other countries when it comes to the rate of patients harmed or killed by adverse events in hospitals, but without generally accepted standards accurate comparison is difficult, said the institute’s CEO.

“If you look at studies that have been done out of all of those countries, and the methodologies are somewhat different, the rate of harm in hospital care is anywhere between about six per cent and 11 per cent,” said Chris Power, a Nova Scotia-trained nurse and former top administrator in the now-defunct Capital Health District.

“In Canada, we fall at about the 7 1 ⁄ 2 per cent (mark), so we still are harming people at an alarming rate but we aren’t the worst in the world.”

Nova Scotia is one of the few provinces and territories that tracks and publicly reports inhospital patient harm. But even within Canada, it is difficult to determine which provinces are doing better than others, said Power.

Nova Scotia health officials say they use the public reporting website to track and improve patient care.

“No patient should ever have to experience these types of events,” said Halili-Banks. “That’s why serious reportable events are called ‘never events.’ They are rare, but still occur. Their ongoing presence underscores the need for monitoring, public reporting, training and process improvement.”

The patient safety institute, which includes membership from all the provinces and territories, published a list of 15 “never events” in 2015, and the following year issued a paper in conjunction with the Canadian Institute for Health Information listing ways to reduce or eliminate them.

The patient safety institute doesn’t assess blame or have any authority to force provinces to change their practices, said Power, but it gathers information and recommends solutions to help improve hospital outcomes.

“There is good evidence that if you put in place these processes in your organization, these things should never happen,” she told The Chronicle Herald.

“We know that to get to zero is probably not going to happen in my lifetime but we should be aspiring to it, and if it was your child, or mother, or spouse, or whoever is important to you, zero would be the answer.”

Although most hospitals in Canada and elsewhere still record occurrences of “never” events, she said, there is no acceptable standard of how many should be allowed.

“We never say this is just a cost of doing business,” Power said. “It is never acceptable to harm a patient. We know that it will happenbecause hospitals are complex patient places.Any healthcare environment is a complex place and there are many issues in the system that contribute to harmful events, but

(zero) is what we should always be striving for.”

One of the biggest problems, she said, is that not all provinces and territories make records of patient harm events public, and few agree on how to define or record them.

The Canadian Institute for Health Information gathers some of that information off charts from each province and territory, but if the events aren’t all measured or recorded the same way, it’s difficult to establish comparisons between jurisdictions, Power said.

“This is the problem in Canada,” she said. “We don’t have a national reporting system.

“We don’t have legislative authority to standardize. There are pockets where we are working with other organizations. As an example, antimicrobial resistance. That’s the big one in the country. We’re now trying to standardize how do we measure infection prevention and control.

“The (2016 paper on) hospital harm measure was an attempt to say OK, at least let’s be on the same page across the country on some specific indicators so we can measure and compare ourselves. That’s been successful.

“But to wholesale across the country say we’re going to measure every single thing and we’re all going to do it the same way with each province responsible for their own health care and monitoring and measuring, it’s been very, very challenging to do that.

“So rather than to try to boil the ocean, we’ve taken small pieces and tried to standardize onthose.”

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