St. Michael’s wound care team partners with Downtown CORE to support patients experiencing homelessness
The St. Michael’s Hospital wound care team is supporting a pilot program to teach wound assessment and management tailored to unhoused populations. The team recently collaborated with the Downtown Community Outreach Response and Engagement (CORE) Team – a pilot program launched by Toronto Public Health (TPH) and the Toronto Police Service (TPS) – in support of vulnerable people living in the Yonge and Dundas area.
The training program teaches public health nurses how to assess and provide wound treatment on the spot, how to document their experiences with patients, and how to identify which wound care supplies should be on hand, such as bandages, saline solution, antimicrobial dressings, and patient education hand outs about chronic wounds.
“Many wound care courses assume that people experiencing homelessness, or the medical staff caring for them, have access to running water, medical supplies and a sterilized area. Although healing wounds is the ideal goal, the reality is that preventing wounds from getting worse is often the best that can be done,” said Janeth Velandia, Nurse Practitioner at St. Michael’s and one of the instructors of the wound care course.
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The wound care team is an interdisciplinary team within St. Michael’s trauma program that includes a nurse practitioner, an occupational therapist, three clinical nursing specialists, and three chiropodists. They specialize in providing patient care to people with complex wounds, such as chronic lower leg ulcers, infections and diabetic foot ulcers, and provide training for this type of care to other teams at the hospital. Similar to the Stop the Bleed training taught by St. Michael’s trauma program, which teaches bleeding control techniques for emergencies outside the hospital, the Wound Care team developed a specialized course for TPH nurses on how to treat chronic wounds for people living on the streets with complex medical conditions.
“We have the knowledge and expertise to apply best practices guidelines; however, their implementation must reflect the realities of the populations we serve,” said Janeth Velandia. “We want to provide information that reflects real-world practice and create an approach that is truly interdisciplinary.”
The Downtown CORE Team and St. Michael’s Hospital both provide care for the same population of patients experiencing homelessness. These patients often go through a cycle where they come to the emergency room with chronic wounds, receive treatment, and then go back into the community. They are often experiencing multiple complex health issues and face significant barriers to completing treatment plans.
To ensure a holistic approach of care for this population, the wound care team has taken an interdisciplinary approach to the development of their own training and education from around the hospital. They also worked with other health disciplines, including dietitians, who shared valuable insights. The dietitians focused on practical, real-life nutrition tips for this population and created a budget-friendly list of healthy food options that can be found at dollar stores.
“As an occupational therapist, I help out in our outpatient clinics and am aware of best practices for pressure injury prevention,” said Kristin Morrow, occupational therapist at St. Michael’s. “But it can be really hard to implement some of those practices if you’re living on the streets or you don’t have a bed to rest and elevate your legs. So I try to think of some of my former patients and cater my teaching to that population.”
The Downtown CORE Team plans to incorporate this specialized wound care training in the onboarding process for public health nurses, fulfilling the program’s wider initiative to provide client-centered services and on-the-ground outreach.
“In the hospital we often take things, like the availability of supplies for granted, and put too much onus on ideal wound care,” said Nat Rave, chiropodist at St. Michael’s. “In the community, it’s very interesting how the CORE team is able to pivot and adapt care based on the client’s needs and what the client will allow. It was nice to have an all-encompassing view of our population and work with our community partners.”
By Lois Lee
Photo by Katie Cooper