OntWIG Symposium 2011ontwig.rnao.ca/sites/ontwig/files/Proceedings_2011_Symposium.pdf · Presented...

OntWIG Symposium 2011 Quality, Risk, Accreditation – Towards a Wound Management Strategy

Proceedings

The cover page image is a word cloud created from the output of the Symposium Roundtable Sessions.

Table of Contents

A Message from the Symposium Chair 5 The Power of Dialogue 6 Executive Summary 7 TURNing: From Data to Policy to Practice 9 Health Quality Ontario: The Excellent Care for All Act and Wound Care 10 Accreditation Canada: The Pressure Ulcer Prevention ROP 11 Policy Basics for Advancing the Ontario Woundcare Management Strategy (OWMS) 12 The Expert Panel 13 The Roundtable Sessions 15 Acknowledgments 19 List of Participants 20

Quality, Risk, Accreditation: Towards A Wound Management Strategy 5/22

A Message from the Symposium Chair

On October 7 2011 we embarked on an important journey.

The 2011 OntWIG Symposium brought together public and private health sector leaders focused on a single mission – how to begin designing a strategy for improving access and delivery of quality wound management services in Ontario.

As Chair I was thrilled with the extraordinary interest and participation in OntWIG’s 3rd Annual Symposium. We learned that our differences were indeed our strengths. We realized that regardless of what sector we represent, we all face the same systemic issues that impact our ability to progress and innovate. We also realized that a lot of energy and resources are being expended working on these issues in silos and if harnessed and with a renewed focus on collaboration we have the potential to transform wound care in Ontario.

This report is a synthesis of what happened at the 2011 OntWIG Symposium. It captures the essence of what was heard from the speakers who presented facts, insights and ideas. Most importantly, the report summarizes the content of the dialogue between the participants, which took place in two roundtable sessions during the day.

I urge you to become familiar with the issues and to join OntWIG in continuing this journey towards an Ontario Wound Management Strategy. Collectively we can chart a path to making the necessary changes to enable the delivery of the highest quality wound care to our patients.

Finally I would like to take this opportunity, on behalf of OntWIG’s Executive and members, to thank our sponsors and volunteers for their support in making the Symposium a major success.

Laura Teague President, OntWIG


The Power of Dialogue Shifting from Self Interest to Common Cause

The 2011 Symposium drew representation from a diverse group of stakeholders from the acute, long term care and community sectors. Notwithstanding a line-up of outstanding speakers, the most powerful part of the day occurred during the more informal parts of the agenda. Prompted by the roundtable sessions and through casual conversation, attendees discovered that they shared the same concerns and frustrations with the state of wound care in Ontario.

What if?

Too often in healthcare we focus on managing issues based on our own perspectives, biases and agenda. Wound care is no different. Often the result is that the best interests of the patient are overshadowed by the desire to preserve existing processes and structures. What if we were able set aside our own self interests and tackle wound care issues with a common purpose?

To do so requires breaking down existing barriers to collaboration and building trust. This can be accomplished by a declaring a shared commitment to being fully transparent in our interactions and operating in an ethical way.

New Alliance Formed

We have promising evidence that silos are being broken down in the wound care community in favour of building alliances to pursue a common goal. In 2011, the wound care industry teamed up with OntWIG, the Canadian Association for Enterostomal Therapy (CAET), and the Canadian Association for Wound Care (CAWC) to plan a Wound Innovation Summit for 2012. The Summit will explore opportunities to advance a national wound care innovation agenda.

Real Change

Sustainability in healthcare is the defining issue of our time. If we can agree that wound care in Ontario needs real change, it is important to be cognizant of the need for affordability in whatever change plan is developed.

In the end, real change will need more than a plan. It will need a relentless commitment by all stakeholders to a common purpose and a common voice to advocate for the change we wish to see.


Executive Summary

On October 7 2011 a cross-section of health care executives, managers, clinicians and wound care industry representatives met at the International Healthcare Education Centre in the Li Ka Shing Knowledge Institute at St. Michael’s Hospital in Toronto. Together, the 150+ participants shared their ideas for tackling the fragmented, uncoordinated and uneven access to and delivery of quality wound management services across the Province of Ontario. The Symposium was presented by the Ontario Woundcare Interest Group (OntWIG), an affiliate interest group of the Registered Nursing Association of Ontario (RNAO). Composed of interdisciplinary health care professionals from all care sectors, their mandate is to influence wound prevention and treatment policy in Ontario. In 3 short years, OntWIG has established itself as a reliable resource to Ontario health sector practitioners and decision-makers. To date, their accomplishments include: � Passage at the 2011 RNAO

AGM of a resolution to advocate for a comprehensive cross-sector interdisciplinary provincial wound care strategy”; and

� Collaboration with Accreditation Canada on a ‘required organizational practice (ROP)’ for pressure ulcer prevention for additional health care sectors.

The 2011 Symposium was planned as the next step in meeting the goal of the AGM resolution. With this in mind, the organizers had three main objectives (i) elevate wound care on the Ontario public policy agenda; (ii) engage broad representation of the wound care community and (iii) create an action plan. The day was structured to include a combination of speakers and interactive discussions intended to provide food for thought and spark ideas for re-imagining wound care in Ontario. Dr. Bergstrom’s presentation highlighted the importance of re-examining widely-accepted practice of turning to prevent pressure ulcers. Eileen Patterson’s review of the Excellent Care for All Act and the role of Health Quality Ontario (HQO), revealed the importance of meaningful data in quality improvement planning. Gregory Kennedy, representing Accreditation Canada, spoke of the successful collaboration with OntWIG to develop a required organizational practice (ROP) for pressure ulcer prevention. Lastly, Dr. Catallo provided insight into the importance of evidence and knowledge brokering in the policy making process.


Throughout the day, attendees participated in roundtable discussions. During the morning session, they were asked to identify priority issues to be addressed in an Ontario Wound Management Strategy (OWMS). After considerable discussion the following issues emerged. 1. Need for standardized

assessment tools across the continuum of care

2. Lack of a shareable electronic

record 3. Failure of existing data

collection tools 4. Inequitable access to

specialized expertise 5. Inequitable access to

equipment and supplies Symposium participants were in agreement that the current system of fractured resources and siloed efforts was overdue for major change. But all was not good news. Further discussion revealed a high degree of frustration that wound prevention and care in Ontario has not received the same attention and investment as stroke care, diabetes and other health priorities. The afternoon roundtables focused on the process for developing an effective strategy.

The ideas generated including the who, what, how and when were intended to be used to inform next steps. And finally, to close out the Symposium, an expert panel made up of representatives from the research, academic, clinical and government communities reflected on the key elements of an Ontario wound care strategy. They concluded that: • Solutions need to encompass

the entire continuum of care • Involvement of all key

stakeholder groups is critical • A universal and comprehensive

electronic documentation system and database for wound management are critical elements of an Ontario strategy

• There is a need to establish a

Canadian advisory body, similar to National Pressure Ulcer Advisory Panel

• All stakeholders are engaged

and ready to collaborate This report will inform the creation of a strategic framework that will guide OntWIG’s work with the RNAO on an Ontario Wound Management Strategy proposal for submission to the Ontario Ministry of Health and Long Term Care (MOHLTC).


TURNing: From Data to Policy to Practice Presented by Nancy Bergstrom, PhD, RN, FAAN, Co-developer of the Braden Scale for Pressure Sore Risk

What We Learned

Dr. Bergstrom is widely known on the international stage for her research that focused on the etiology of pressure sores. Most know Dr. Bergstrom for leading the research that established the reliability and validity of the Braden Scale for Predicting Pressure Sore Risk. Her most recent research underway is a randomized controlled trial of pressure ulcer prevention strategies that is funded by the National Institutes of Health, National Institute of Nursing Research, National Institute on Aging and Ontario Ministry of Health and Long Term Care ($2.5 million). The Turning for Ulcer Reduction (TURN) study examines the worldwide practice of turning immobile patients every 2 hours. Inherent in this practice dating from the 1960’s are (i) a decreased quality of life for the patient and (ii) an impossible standard that is very resource-intensive. The TURN study is a large multi-site clinical trial at 28 sites of which 7 are in Canada. Involving 8 diverse disciplines ranging from nursing and medicine to physics and health economics, the study considers the impact of high density surfaces and

breathable fabrics on currently accepted turning schedules. While Dr. Bergstrom was unable to speak about the results of the study, she intimated that the preliminary findings, if confirmed, will have significant policy and practice implications. Not only will turning schedules be modified based on the new research, but the importance of risk assessments will factor into the potential for improved resource use. At a time when governments everywhere are challenged to find ways to make health care sustainable, Dr. Bergstrom’s work takes on an elevated importance.


Health Quality Ontario: The Excellent Care for All Act and Wound Care Presented by Eileen Patterson, BA, MCE, Director of Quality Improvement, Health Quality Ontario (HQO)

What We Learned

Ms. Patterson brings expertise in health service integration, self-management, access, efficiency and clinical care improvements for primary, specialty, and long term care programs. Declaring a new day for quality in Ontario with the passage of the Excellent Care for All Act in 2010, Ms. Patterson spoke about HQO’s role. Besides overseeing the mandated quality improvement plans (QIPs) in Ontario hospitals and long term care homes, HQO also makes recommendations for funding services and medical devices in consultation with the Ontario Medical Advisory Secretariat and the Ontario Health Technology Assessment Committee. With the HQC Ontario goal of working on high value initiatives, Ms. Patterson provided an overview of some of the ongoing wound care-related initiatives. The Residents First Program in LTC homes has produced significant improvements in pressure ulcer prevention. An important component of the Program is a public website containing monthly reporting of (i) % of residents with Stage 1-4 pressure ulcers, (ii) % of

worsening pressure ulcers and (iii) % of newly identified pressure ulcers. A partnership between the MoHLTC, the Ontario Association of Community Care Access Centres (OACCAC) and the Rotman School’s Collaboration for Health Sector Strategy resulted in the Integrated Client Care Project (ICCP). This project focused on process improvement for the care of diabetic foot ulcers and venous leg ulcers in a community setting. The pilots are being evaluated but preliminary findings suggest broader system changes ahead including new models for paying for wound care. Having cited a number of exciting initiatives from HQO, Ms. Patterson provided the ingredients for her recipe for quality improvement. � Information on quality � Best evidence � Planning � QI skills/capacity She concluded her remarks by stating her firm belief that Ontario can be the best performing health system in the world.


Accreditation Canada: The Pressure Ulcer Prevention ROP Presented by Gregory Kennedy, Health Services Research Specialist, Program Development, Accreditation Canada

What We Learned

An early supporter of the potential for required organizational practices (ROPs) to transform the practice of wound care, OntWIG was pleased to be able to welcome Mr. Kennedy to the Symposium. In his role with Accreditation Canada, Mr. Kennedy oversees the ongoing development and maintenance of the accreditation program, particularly in terms of ROPs, performance measures, patient safety, and client experience. Over the past year, OntWIG and Accreditation Canada have been collaborating on a ROP for pressure ulcer prevention (PUP.) Because there was evidence that standardized prevention and treatment protocols can reduce the prevalence of pressure ulcers, improve client quality of life and caregiver morale while reducing health services costs, a PUP ROP was made a priority. The process of developing an ROP is a lengthy one that includes extensive consultation with client organizations, surveyors, ministries of health and national partners.

Once introduced to an organization, each patient’s risk for developing a pressure ulcer is assessed using a standardized risk tool and interventions to prevent pressure ulcer development are implemented at regular intervals. The organization uses evidence-based protocols and procedures to prevent the development of pressure ulcers, which include interventions to prevent skin breakdown, reduce pressure, reposition, manage moisture, maximize nutrition, and enhance mobility and activity. Education of staff about risk factors for pressure ulcers and strategies for the prevention of pressure ulcers are also part of the program. The ROP is an excellent lever to increase uptake of best practices. While initially developed for the long term care sector, next steps include spreading applicability of the pressure ulcer prevention ROP to acute care and rehab services.


Policy Basics for Advancing the Ontario Woundcare Management Strategy (OWMS) Presented by Cristina Catallo, RN, PhD; Associate Professor, Daphne Cockwell School of Nursing, Ryerson University What We Learned

With an expertise in health policy, Dr. Catallo provided insights into how the OWMS project can utilize the tools of knowledge translation to access policy makers and keep their attention. Faced with competing requests for scarce resources, bureaucrats and policy makers struggle to find the right balance between (i) institutional constraints, (ii) perspectives, values and influences of stakeholder groups, (iii) multiple evidence sources and (iv) other external pressures. “What’s evidence got to do with it?” High quality evidence supports policy makers’ ability to address complex issues and achieve government goals by improving the decision making process. So how do we increase the uptake of high quality wound care evidence? One key, according to Dr. Catallo, lies in knowledge brokering where the research community develops relationships grounded in expertise and credibility with the policy community. Overtime, researchers can become “trusted advisors” to government and

wield powerful influence on the policy process. But what is the capacity of Canadian policy makers for evidence-informed decision making? As principal investigator, Dr. Catallo has undertaken a study of Canadian health ministries to look at variations in abilities to access evidence and skills to interpret evidence. Her preliminary findings suggest that, generally, all ministries are supportive of the bureaucracy using high quality research. Where there is considerable variation is in the existence of formal networks for evidence sharing. In the end, Dr. Catallo advised that being successful in influencing policy you need to � Synthesize evidence; � Translate evidence into

messages that policy makers can use;

� Participate in networks where

bureaucrats are invited; and � Serve as knowledge brokers

for policy makers.


The Expert Panel

What We Heard Nancy Purdy, OntWIG’s Health Policy Director, moderated an expert panel composed of � Nancy Bergstrom, an international expert clinician, representing the research

perspective; � Cristina Catallo, from Ryerson University, representing the knowledge

translation perspective; � Sarah Clemens, from RNAO, representing the professional organization

perspective; � Corinne McIsaac, from Health Outcomes Worldwide, representing research; and � Eileen Patterson, from Health Quality Ontario, representing government. Nancy opened the discussion by asking the panelists several questions and inviting them to reflect on what they heard throughout the day. The following are a few highlights of the panel discussion. “What can we do to facilitate collaboration among stakeholders?” One panelist spoke about the importance of engaging the medical community in the process of developing an Ontario Wound Management Strategy. Not only do they bring a unique and sometimes under represented perspective, they can open up pathways for certification of wound care providers similar to what exists in the United States. With certification comes added profile for wound care as an area requiring specialized knowledge and expertise. To encourage engagement and collaboration among stakeholders, including the medical profession, it was suggested that a Canadian affiliate of the NPUAP be established. In that way, Canada could leverage the relationships, resources and reputation that already exists on the international stage. “How can a wound care strategy be advanced and supported by MoHLTC?” Many of the panel members raised the importance of collecting good data to support the development of a province-wide strategy. While there are data collection tools and electronic databases in use, it is their inoperability across systems and regions that make them less than effective when considering a provincial wound care


strategy and policy. For example, too often individual LHINs are purchasing data collection tools with limited compatibility to other electronic records in development. In addition, some panel members expressed concerns about privacy issues when the data is collected and housed outside the public system. This raised many questions from the panel including (i) who owns the data? (ii) can it be sold? and (iii) what is in the public’s interest? So what should one conclude from the panel, as a whole? • There was consensus that, while the Province is demonstrating interest in

improved management of wound care, solutions need to encompass the entire continuum of care.

• Involvement of all key stakeholder groups is critical. In the past, patient groups

have not been well-represented. • The panel expressed unanimous support for advocating for an electronic

documentation system and provincial database for wound management tool that, in turn, would support benchmarking, evaluation and research activities.

• Consideration should be given to establishing a Canadian affiliate of NPUAP in

order to tap the expertise and learnings that already exist and may be transferable to our healthcare system.

• As the bottom-line, the level of engagement by Symposium participants was

confirmation that the Ontario wound care community is fully invested in advocating for improvements in wound management.


The Roundtable Sessions In keeping with the power of dialogue concept, a series of roundtables discussions throughout the day enabled Symposium participants to come together and brainstorm ideas related to the Challenges presented. There were 10 roundtables set up this purpose. The results of these sessions have been summarized in the charts that follow.

Challenge 1 In defining the goals and key elements of a cross-sectoral interdisciplinary wound management strategy, participants were asked to identify the issues that need to be addressed within the Ontario Woundcare Management Strategy i.e. what was the key content to be included in the strategy. Issue: Need for standardized assessment tools across the continuum of care BIG IDEAS or Growing the Economy Issue: Lack of an accessible interdisciplinary electronic record

1 Every sector and/or facility uses different systems for documentation (i.e. paper,

computer, mixed). 2 Lack of consistency, accuracy and standardization in the staging of pressure ulcers

produces gaps that can create confusion particularly when pressure ulcers are documented in more than one location within a patient record using different definitions.

3 Variation in the use of staging definitions can negatively impact patient safety. Incorrect

staging practices can potentially threaten access to additional funding needed for appropriate care when patients have high intensity needs.

4 There is a need to develop and make mandatory a consistent language with

standardized methodology and clear definitions for measuring wound etiology.

1 Lack of an electronic record limits collaborative practice and interdisciplinary, cross-

sectoral communication, which can negatively impact wound healing trajectories. 2 It is essential that wherever the patient goes their e-record goes with them. 3 Consideration should be given to looking elsewhere (e.g. other parts of Canada, the

UK, Australia, USA) for existing registries that Ontario could join therein allowing Ontario to participate in global wound care research initiatives.


Issue: Failure of existing data collection tools Issue: Inequitable access to specialized expertise BIG IDEAS or Growing the Economy Issue: Inequitable access to equipment and supplies BIG IDEAS or Growing the Economy

1. There is no standard definition of what constitutes a wound care specialist – i.e. no minimum

credentials, education and experience. 2. The supply of wound care expertise is limited and cannot meet existing demand. 3. There is limited funding for capacity-building activities. 4. True inter-professional collaboration is sub-optimal. 5. Ineffective use of wound care consults results in treatment plans/protocols not being

understood or followed but often changed because of competing agendas/incentives.

1. Procurement policies and processes need improvement to ensure continuity, consistency

and timeliness. 2. Great variation exists in equipment availability across the system e.g. access to therapeutic

surfaces and pressure management devices in a timely fashion for both prevention & treatment. Access is inconsistent across sectors and LHINs.

3. Excess wait-times for equipment negatively impact patient outcomes. Clients crossing

various sectors should not be denied continued access to treatment during this transition period.

4. Weak linkages between OHTAC recommendations, policy and actual uptake in practice may

lead to ineffective allocation of resources. 5. Group buying is cumbersome e.g. little consideration of factors beyond price.

1 Existing tools have limited value for informing treatment decisions. 2 Too often decisions about the purchase and use of data collection tools are made without

consideration for system-wide interoperability therein lessening their value for research purposes.

3 Current databases used for benchmarking and planning include a variety of staging

definitions and are not consistent with best practice guidelines; and variations in definitions between HOBIC, RAI-MDS, CIHI Discharge Abstract Database make their utility worrisome.


Challenge 2 In creating a road map for an Ontario Wound Management Strategy, roundtable participants were asked to consider key process questions i.e. what processes could be used to develop the Ontario Woundcare Management Strategy. Why?

What? Who? Issue: Inequitable access to specialized expertise

1 Raising the profile of wound care with stakeholders will enable informed decision-making

about the allocation of scarce resources. 2 Investing in a comprehensive, strategic and planned approach to wound management in

Ontario will reduce LOS; decrease readmissions and improve patient outcomes. 3 As governments struggle with the current fiscal realities of a world economy in crisis,

improving value for money in our health system will be met with considerable interest by policy makers.

A system-wide approach to wound management that (i) seamlessly follows the patient across sectors with the appropriate transfer of accountability at transition points; (ii) utilizes the optimal mix of professionals; (iii) providing evidence-based care including accessing the right products at the right time and (iv) has buy-in from all stakeholders and supports high quality research.

1 Involve all stakeholders: academics and researchers, Associations, administrators,

professional organizations, corporations, patients, families and government. 2 Seek out clinical input from Chiropodists, Dietitians, ETs, Geriatricians, Mental health

workers, MDs, NPs, Nursing, Orthotists, OTs, Pharmacists, PSWs, PTs, and Social Workers.

3 Hire a strategist to consult, plan and develop a framework as the basis for advocating for

improvements to wound care in Ontario. 4 Identify a champion or champions to advocate for the necessary investments and public

policy supports.


How?

When?

When?

When?

Roundtable Wrap Up With benefit of the insights shared during the Roundtables, OntWIG is well-positioned to start to create a framework for an Ontario Wound Management Strategy. This work will be undertaken in consultation with key opinion leaders and shared with its membership in early 2012. OntWIG will be working with the RNAO to develop an Ontario Wound Management Strategy proposal for submission to the Ontario Ministry of Health and Long Term Care (MOHLTC).

1 Consider creating an advisory group with key leaders representing academic, business,

clinical and health policy segments. 2 Patients’ and families’ experiences need to be incorporated to highlight the need for change.

They can become patient advocates and work along side the OWMS leadership. 3 Align strategies with other provincial initiatives already in place e.g. chronic disease

strategies.

1. The consensus was that the time is right to move forward without delay to develop a made-

in-Ontario wound management strategy. 2. It was recommended that this initiative be developed in concert with other similar or

complementary provincial or federal wound care initiatives. 3. Clear timelines, accountability and ownership should be first steps. 4. Consideration should be given to reconvening the Symposium participants again in 2012 to

report progress.


Acknowledgments We gratefully acknowledge our sponsors, planning committees and volunteers for their support, without which the Symposium would not have been possible. Breakfast Sponsor Molnlycke Healthcare Lunch and Bio Break Sponsors Revera Health Outcomes Worldwide Patron Level Sponsors 3M ConvaTec Healthpoint KCI Saint Elizabeth Tena Supporter Level Sponsors Arjo Huntleigh Derma Sciences Essential Wound Management Inc. Hollister McArthur Medical Sales Inc. Smith&Nephew Systagenix TPOT VHA Home HealthCare We Care OntWIG Executive Laura Teague, President Nancy Purdy, Health Policy Elaine Calvert, Communications Valerie Winberg, Finance and Administration Juliana Vidacs, Nursing Student Rep

Symposium Organizing Committee Karen Laforet Nancy Parslow Debbie Hanna-Bull Larissa Mourdova Rosemary Kohr Roundtable Facilitators Rosemary Kohr Ann-Marie McLaren Karen Campbell Gina Trubina Anita Stern Debbie Hanna-Bull Janice Hon Valerie Winberg Elaine Calvert Roundtable Recorders Karen Bruton Peggy Ahearn Lyndsay Orr Beth Clarke Sheila Rose Toba Miller Joanne Greco Laurie Goodman Lina Martins Sandra Tully


List of Participants Aal, Patricia Ahearn, Peggy Adam, Jackie Alexander, Cathy Andonoff, John Anjos, Melissa Audette, Leo Baltazar, George Bergstrom, Nancy Bremer, Margaret Brimer, Jan Bruton, Karen Burke-Martin, Patti Byberg, Kim Calabrese, Susan Calvert, Elaine Campbell, Karen Catallo, Christina Chadwick, Stephanie Chambers, Sherry Chen, Hui Clemens, Sara

Clarke, Beth Colucci, Karen Cowie, Barbara Crawford, Peter Cromwell, Melodie Crowe, Alexandria Daley, Lorraine Devi, Laurie Dudziak, Sandra Dyckman, Joanne Edwards, Laverne Elkami, Berna Engel, Mary Filinska, Basia Gallant, Shelley Gardner, Peter Gander, Jolayne Geen, Greg Gies, Helen Goodman, Laurie Gregory, John Ham, Denece

Hanna-Bull, Debbie Haratsidis, Eva Harris, Connie Henderson, Theresa Herriott, Bonnita Hill-Longo, Shannon Hind, Sarah Hon, Janice Howell-Belle, Carnett Ilmer, Irina Jackson, Oona Jones-Lim, Lilibeth Kasiuk, Helena Kassahun, Firehimot Kennedy, Gregory Klein, Ann Kohr, Rosemary Kleinsteuber, Fran Lane, Linda Larlain, Ann Latocki, Maureen Laughlin, Tamra


Leber, Diane Legare, Kathryn Lees, Jane Martino, Debbie Martin, Heather Martins, Lina Mair, Leila Malizia, Beata McIsaac, Corinne McLaren, Ann-Marie Mings, Deborah Miller, Toba Manderson-Gray, J Moralejo, Joshua Mouradova, Larissa Mudge, Beatrice Muhammad, Sukaina Mundy, Brenda Munger, Stephanie Murray, Holly Noble, Cara Orr, Lyndsay

Paczkowski, Joanna Patterson, Eileen Parslow, Nancy Perchard, Jo Ann Pham, Ba Plouffe, Jennifer Prashad, Anubha Prendi, Mark Price, Linda Purdy, Nancy Ray, Karen Rose, Sheilagh Sanford, Susan Savoie, Sue Scattolon, Maria Selent, Debbie Sewda, Raj Sheraly, Zaynab Smith, Heather Spurgeon, Jason Stern, Anita Stephen, Rob

Stokes, Donald Stone, John Stuart, Shelagh Teague, Laura Tully, Sandra Thai, Thao Thompson, Ruth Trubina, Gina Velandia, Janeth Vidacs, Juliana Welch, Rachael Williams, Beverly Winberg, Valerie Zayani, Foroozan


Ontario Woundcare Interest Group (OntWIG) We are a group of interdisciplinary health care professionals representing all health care sectors who leads, promotes and influences wound prevention and treatment public policy for all citizens in our Ontario Health Care System. All inquiries including membership requests may be directed through our website. http://ontwig.rnao.ca/contact

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