A new tool in Manitoba’s wound care tool kit

By Mike Daly
Winnipeg Regional Health Authority
Published Tuesday, October 22, 2019

Home improvement enthusiasts know that you can never have too many tools. The same can be said for health care professionals, who are always on the lookout for new clinical treatment options to add to their toolkit in support of improved patient health.

Thanks to a dedicated team of professionals at Deer Lodge Centre (DLC) – Winnipeg’s 419-bed long term care and rehabilitation facility – there is a new treatment option for the care of chronic wounds that are resistant to healing.

In late 2016, the DLC team was the first in Manitoba to explore the use of electrical stimulation for wound care. While the technology itself is not new – it has been proven to accelerate wound healing and increase blood flow to wounds, and is already in use in other jurisdictions in Canada and elsewhere – it had not yet been used in Manitoba, due mainly to the lack of local expertise and protocols.

“Three years ago, the WRHA’s Regional Wound Committee was looking at the guidelines for wound care, and identified that there was good research for electrical stimulation, but that it wasn’t being used in Winnipeg or Manitoba,” says Kathleen Klaasen, DLC’s Chief Nursing Officer. “We started asking questions like, why not? Can we make it happen here? How do we use it? Under what guidelines? Susan Bowman, our Manager of Physiotherapy said, ‘I think we can do this at Deer Lodge Centre. Let us be the site that tries this out.'”

To the layman, wound care might seem rather basic and uncomplicated, but the fact is that some chronic wounds can defy even the best efforts of expert caregivers to promote tissue repair. Some chronic wounds heal very slowly, do not heal at all, or worsen despite the use of rigorous wound care treatments and medications. Reasons for this are varied, but can include poor circulation, infection, edema (fluid that accumulates in the skin), inadequate nutrition and repetitive trauma to the wound site.

Cara Windle, Clinical Service Lead for Physiotherapy for DLC, explains how the trial got underway.

“For the electrical stimulation trial, we identified a patient with a pressure wound that hadn’t healed or closed over a two year period despite multiple interventions, medications and treatments. Using Electrical Stimulation Therapy similar to that provided by a TENS machine (electrical pain-relief technology common in physiotherapy departments throughout the province), the patient received 60 minutes of electrical stimulation of his wound site four or five times per week. Within 12 weeks, the wound’s size had been reduced by 98 per cent, and eventually, in combination with other interventions, it closed entirely.”

Because the trial employed technology already proven to work, the results weren’t totally unexpected, Windle says. Rather, the trial’s importance came in the form of supplying the local know-how necessary to add electrical wound stimulation to an already-diverse set of wound care tools available to facilities in Winnipeg and Manitoba.

“It’s only one tool, and it’s not going to heal every wound in every situation, but having electrical wound stimulation in your tool box is an excellent option,” Windle says. “With the trial now complete, the region is on the cusp of publishing a new clinical practice guideline that will give local health care professionals the easy-to-follow protocols, communication tools, monitoring tools and interprofessional education roadmap they’ll need to implement this new option for wound care in their sites and clinical programs.”

In recognition of their hard work and success, the DLC team has been named one of three winners of the 2019 Health Innovation Award for Patient Centred Care, which recognizes initiatives “that have directly resulted in positive improvements to processes, clinical approaches, and the culture of patient-centred care.”

Team members for this project included: Daryl Dyck, Clinical Nurse Specialist; Maria Froese, Physiotherapist; Ivan Garcia, Physiotherapist; Cara Windle, Physiotherapist; Susan Bowman, previously Manager of Rehabilitation Services at Deer Lodge Centre.