The number of serious bedsores reportedly found in patients in Nova Scotia hospitals has risen, but the province says it is only because it is counting them differently.
However, a patient safety advocate says that’s no comfort because they shouldn’t happen at all.
The number of stage 3 and 4 bedsores reported by the Health Department in the most recent quarter tripled when compared to the average over the last two years.
“That is not particularly alarming to me based on the data that we have available to us, but certainly overall we are not where we would like to be as an organization and we recognize that we have improvement to do and are very, very committed to doing that work,” said Rochelle Currie, Nova Scotia Health’s senior director of quality improvement.
The average was 21, but there were 70 from October to December 2024, although the province says two of those actually occurred in the previous quarter.
Currie said she is concerned by the latest numbers, but they are not a surprise.
The province annually conducts a one-day blitz in October to identify stage 3 and 4 bedsores, which are the worst ones and can lead to sepsis and death, and last year’s event coincided with a change in policy on reporting that added a new category of injury called “unstageable.”
Currie said studies have shown most unstageable wounds are in fact stage 3 or stage 4 that have started to heal, making them more difficult to identify and categorize.
Nova Scotia Health now reports those wounds along with stage 3 and 4 wounds and that’s why the numbers spiked last fall, she said.
Compared to the same quarter the previous year, the number jumped by 53 per cent, and 49 per cent of those were unstageable, Currie said.
The numbers are reported quarterly on the Health Department’s serious reportable events website. The province calls them pressure ulcers, but they are bedsores, also known as pressure wounds or pressure injuries.
Currie said if the “unstageable” numbers are removed, the worst bedsores acquired in hospital are up only a little bit.
But they’ve been a stubborn problem for years.
The Canadian Institute for Health Information does not track data nationally on just stage 3 and 4 bedsores, but it does have total numbers and the incidence rates for all stages of bedsores reported in hospitals across Canada.
The numbers show Nova Scotia’s incident rate has been consistently higher than any other province over the last five years, and that its total numbers and incidence rate doubled two years ago.
The institure says it’s not possible to compare one province to another because patient populations differ.
Currie said Nova Scotia hospital patients are typically older and frail and they tend to have multiple chronic health problems that make them more susceptible to bedsores.
She said it’s not clear why the province’s numbers rose two years ago, but officials are now refocusing their efforts by taking a provincewide approach to sharing best practices.
“Pressure injuries are something that the organization takes very seriously and something that we’re committed to improving,” she said.
“In fact, pressure injury prevention has been identified as one of the organization’s top priorities.”
Katharina Kovacs Burns, chair of Patients for Patient Safety Canada, said she believes the number of hospital-acquired bedsores is not accurately recorded across Canada and that the incidence is actually higher.
The organization advocates for patient safety from all kinds of harms, but the number of bedsores that reach stage 3 or 4 in hospital is a critical concern, she said.
“Pressure injuries are one of those hidden kind of incidents that seem to creep up, but when they do happen and it results in the skin breaking, then it is very difficult to heal.”
“By the time they reach stage 3 [or] 4, that means that definitely there has not been the attention given to do risk assessment or to reposition patients or to attend to them in a way to prevent that skin from breaking, so that’s the alarming part.”
Kovacs Burns said there are a variety of reasons people get bedsores, but with care, they should not progress to the worst stages.
“It is a never event. It is preventable and so I think there isn’t for me an acceptable level. It should just never happen.”
Kovacs Burns said family can help busy health care staff prevent bedsores from becoming a problem.
She said patients need to be checked regularly and shifted in bed or provided with devices to prevent bedsores from becoming unhealthy wounds.
