Ross Tilley Burn Centre Patient & Family Information
Table of Contents Introduction 3 GOALS OF THE BURN CENTRE 3 MEET YOUR BURN TEAM 3 FRIENDS & FAMILY 4 Flowers are not allowed 4 Food 4 No Smoking 4 Public Washrooms 4 Chaplaincy Services 4 Hospital Cafeteria 5 Parking 5 Temporary Accommodation 5 Valuables 5 Spokesperson 5 THE BURN TEAM 6 Medical Staff 6 Nursing Staff 6 Physiotherapist 6 Occupational Therapist 7 Social Worker 7 Respiratory Therapist 7 Dietitian 7 BURN INJURIES 8 The Skin 8 Depth of Burn 8 BURN TREATMENTS 9 Hydrotherapy (Burn shower) 9 Pain Medication 9 Dressings 9 Swelling 9 Ventilators 9 NG Tube 10 Diet 10 Surgery 10 GOING HOME 11 CONCLUSION 11 QUESTIONS TO ASK 11 2
Introduction A burn injury can be a terrifying experience for you and your family. Hospitalization involves many new faces and experiences in an unfamiliar setting. We hope this booklet will help to answer some of your questions and reduce your fears by making you and your family more familiar with the Burn Centre and the burn team of which you and your family are now a part. GOALS OF THE BURN CENTRE 1. To provide the best possible patient care and to assist patients to resume a productive place in society. 2. To provide a facility for research activities to improve the quality of care for the burn patient. 3. To provide a facility with complete teaching programmes for health professionals and for members of the community. MEET YOUR BURN TEAM The Burn Centre is a fourteen-bed unit with its own operating room, able to handle even the most critically ill patients. The burn team is made up of a group of highly skilled health care professionals including medical staff, nurses, pharmacist, physiotherapist, occupational therapist, respiratory therapist, dietitian, social worker and other support staff. There are also numerous other team members whose roles are vital, but may not participate directly in patient care. 3
FRIENDS & FAMILY Friends and family play an important role in your recovery. A familiar face in new surroundings is a comfort. Hospital visiting hours are from 9 a.m. to 9 p.m. During these hours, you may not always be able to visit due to nursing shift change, a scheduled rest or medical procedure. If this happens, visitors may wait in the Family Lounge, inside the Burn Centre. To find out if the patient is able to visit, please first go directly to the Reception Area telephone located across from the D7 elevator. Press the doorbell button to let the unit know of your wish to visit. A staff member will instruct you regarding visiting procedures. Upon entering the Burn Centre, to reduce the spread of infection, please remember to: Hang up your coat on the hooks provided Wash your hands with the waterless hand rinse gel Put on a yellow gown with the opening at the back Proceed to the nursing station and ask to speak with the bedside nurse caring for the patient you wish to visit Flowers are not allowed Live flowers and plants carry germs which can cause infections and are not permitted in the Burn Centre. Artificial flowers and non-latex (Mylar ) balloons are accepted. Photographs of the patient and family are also welcomed as they provide great encouragement. Food Visitors are welcome to bring you food when visiting. A microwave and refrigerator are located in our pantry, where food can be labeled with your name and stored. Please check with your bedside nurse to see if there are any dietary restrictions. No Smoking Sunnybrook Health Sciences Centre and grounds is a smoke-free environment. Public Washrooms A public washroom is located outside the Burn Centre, near the elevator. Chaplaincy Services If you wish to visit with a chaplain, please ask at the nursing station. 4
Hospital Cafeteria The hospital cafeteria, Harlequins, is located in E wing on the first floor. Open 11:30 a.m. - 3 p.m. Monday to Friday. Closed weekends. Second Cup is located in M wing on the first floor and is open 23 hours/day. On The Go Bistro is there also and is open Monday to Sunday 7 a.m. to 7 p.m. Tim Horton s is located in C wing on the first floor and is open from 7 a.m. to 4 p.m., Monday to Friday. A drink vending machine is located outside Patient Room 14 in the Burn Centre. A small refrigerator, kettle and coffee maker are also available for your use in the pantry. Parking For information, see the Parking Office staff on C wing, Ground floor, Room 01 (CG 01). Hours are 10 a.m. - 5 p.m. Telephone (416) 480-4123. Temporary Accommodation If you need help finding temporary accommodation, please ask to speak with the social worker. Valuables Patients are encouraged to send valuables and money home with a friend or family member. Items may also be locked up in the hospital safekeeping department. A member of the nursing staff will explain the procedure to you. Please note, the hospital cannot be held responsible for valuables left in patient rooms. Spokesperson We ask that you select one spokesperson to keep all family and friends informed about the patient s condition, rather than having many people calling the Burn Centre. 5
THE BURN TEAM Medical Staff Staff burn surgeons oversee all of the care given to patients in the Burn Centre. Under their supervision, other doctors (fellows and residents) are training to become specialized in burn care. Fellows and residents are responsible for providing much of the patient s medical care. Other medical specialists may be consulted if necessary. Nursing Staff Nursing staff are responsible for coordinating all aspects of your care by communicating your needs to various team members. Each patient has a nurse who is responsible for delivering most of the bedside care required. If you have any questions or concerns, please address them to the bedside nurse. Your nurse is with you over a long period of time and usually gets to know you and your family members well. One of nursing s most important roles is to offer as much supportive care as possible. The nurse is also responsible for on-going assessments of your condition and aiding the doctor in his/her medical plan of care. The patient care manager is responsible for the day-to-day running of the Burn Centre and is available to you and your family if you have any questions or concerns. The Burn Centre clinical nurse specialist works directly with you and your family members to provide clinical and psychological support both in the hospital and after you have gone home. The clinical nurse specialist also assists members of the burn team with patient care issues. Physiotherapist The physiotherapist (P.T.) helps you to restore or maintain your ability to physically function. To help you reach your best possible range of motion (ROM) in all limbs, exercises are performed in the hydrotherapy room or during dressing changes when movement is not hindered by bulky dressings. During your hospital stay, the P.T. will also work with you on improving your bed mobility, transfers and ambulation, preserving your strength and endurance and providing any cardiovascular therapy that is required. In consultation with the Burn Centre team, the P.T. may recommend aids such as a cane, crutches or a walker. The P.T. will also work with the occupational therapist (O.T.) to coordinate any therapy that is required once you leave the hospital. 6
Occupational Therapist The occupational therapist (O.T.) assists you to become more independent. This may involve providing therapeutic activities to increase your functional range or ordering special devices (i.e. special handles for utensils) which will allow you to do more for yourself. To ensure appropriate positioning during the wound healing or post-skin grafting phase, the O.T. will make splints which hold your limbs in place. O.T. s also offer psychological support and education regarding scar management and will continue to follow your progress in the outpatient Burn Clinic. Social Worker The social worker is available to provide ongoing counselling and emotional support. Assistance in coping with any difficult or stressful issues is also available. If you need help with practical problems, such as financial assistance, accommodation information or hospital insurance, please feel free to ask. The social worker is located in the Burn Centre, Room D7 39. Respiratory Therapist If you have experienced smoke or heat damage to your lungs (inhalation injury), you may need a ventilator machine to help you to breathe. The respiratory therapist works together with the bedside nurse to monitor your response to the ventilator and adjust the settings accordingly. Dietitian A well balanced, high-protein, high-calorie diet is important for healing burn injuries. Each day, the dietitian will calculate the number of calories you consume to ensure that nutritional requirements are being met. If you have specific food favourites, plaese let your bedside nurse know and the dietitian will come to see you. 7
BURN INJURIES The Skin The skin is the largest organ in the body and performs many important functions. It protects against infection by keeping out bacteria. It prevents loss of body fluids and helps control body temperature. Depth of Burn The depth of burn is usually categorized as superficial partial-thickness, deep partial-thickness or full-thickness. Superficial partial-thickness (also known as superficial second degree) A superficial partial-thickness burn resembles a deep sunburn with blisters and is very painful. It will usually heal on its own within ten days. Deep partial-thickness (also known as deep second degree) A deep partial-thickness burn is also very painful. It may take at least three weeks for all the burned tissue to be removed and for new skin to heal. Full-thickness (also known as third degree) A full-thickness burn involves damage to all the layers of the skin, including the skin-reproducing cells. This wound will require skin grafting to heal. It is not always possible to tell the depth of the injury when a patient is first admitted. It often takes several days to determine whether the burn wound will heal on its own or if it will require skin grafting. The severity of a burn injury depends on the depth and size of the burn wound, the patient s age, the patient s past medical problems and the part of the body which has been burned. It is difficult to predict how long it will take for a patient s injury to heal as all individuals recover at different rates. The team will keep you up-to-date as more information becomes available. 8
BURN TREATMENTS Hydrotherapy (Burn shower) After being admitted to the Burn Centre, you will be taken directly to the hydrotherapy room. Here, you will be transferred to a cart shower and your burn wounds examined and cleansed. Your wounds may also be cleansed in your room. For patients who are well enough, there is also a stand-up shower. Pain Medication Most burn patients experience some degree of pain. Medication is given frequently to decrease the pain as much as possible. Before procedures, such as dressing changes or physiotherapy, additional medication is given to patients. Please let a member of the burn team know when you need more medication. We want to make you as comfortable as possible. Dressings Dressings are applied over the burned areas following the shower. Dressing changes are an important part of wound care. They keep the wound clean and speed the removal of dead skin. Sometimes, it is necessary to surgically remove the dead skin. A variety of creams and dressings are used at different stages of the healing process. First, burn wounds are usually covered with silver sulphadiazene (SSD) cream, which helps to decrease infection. This white cream is then covered with gauze and wrapped to keep it in place. A protective layer of Polysporin ointment is applied to areas of the body which cannot be covered by dressings, such as the face. Polysporin reduces bacteria and helps keep the wound from drying out. Swelling Part of the body s natural response to a burn injury is for fluid to leak out of the bloodstream into the surrounding tissues. The swelling which results is called edema and may be present in your face, arms and legs for several days following the burn injury, before it gradually decreases. It is necessary to put fluids back into the bloodstream through an intravenous (I.V.) catheter. Burn team members determine the amount of fluid required by measuring your urine output. Various replacement fluids are used including blood products. Ventilators For those patients who experience difficulty breathing due to the inhalation of smoke or a swollen burned neck, a tube is placed through the nose or mouth to the lungs. This tube may be attached to a machine called a ventilator, which will monitor and assist the patient s breathing. 9
NG Tube Sometimes after a burn injury, the stomach stops digesting food. If necessary, an NG tube may be inserted. The tube is inserted through your nose into the stomach and a high-calorie, high-protein drink is fed through the tube. This continues until you are able to eat on your own. Diet Nutrition is very important for the healing of burn wounds. The Burn Centre dietitian will visit with you and arrange for a high-protein, high-calorie diet. You are also encouraged to drink high-calorie, high-protein drinks between meals. All of the food you can eat is recorded on a calorie count sheet. This record allows the dietitian to determine if you are eating enough food each day. Family members are encouraged to bring in the patient s favourite foods. Surgery Surgery will be required if the burn wound is full-thickness. The burn wound must be covered with healthy skin from an unburned area of the body. The area from where the healthy skin is removed or harvested is called the donor site. After surgery, the donor site is covered with a dressing and will usually heal within 10-14 days. Dead tissue must be removed from the burn wound before the new skin can be applied. The removal of dead tissue is called debridement or excision. Once the dead tissue has been removed, the healthy skin is placed on the debrided wound. This is called a skin graft. Debridement, harvesting of skin, and skin grafting are performed in the operating room. Once the skin graft is laid, the dressing will not be changed for a few days. It is important not to disturb the newly grafted area. Grafted arms and legs are often kept still using bulky dressings casts or splints. Even with all of these precautions, there may be small areas which require re-grafting. Healing times vary from patient to patient and individual progress is checked daily. Most harvested skin is meshed (slits made in the skin) so that it can be expanded to cover a larger area. The grafted skin will have a checkered appearance when it heals, which will gradually fade with time. If you have any questions, please ask a burn team member. 10
GOING HOME Before leaving the Burn Centre, you will receive a copy of Going Home!, an information booklet to assist you in the final stage of recovery after you leave the hospital. Staff will review the information in this booklet with you and answer any questions you may have before you go home. CONCLUSION We hope that you find this booklet helpful while you are in the hospital. If you have any concerns, please speak to a staff member. Sometimes it is helpful to write down your questions as you think of them so you are prepared when a team member comes to see you. Please use the blank page at the end of this booklet to write down your questions. QUESTIONS TO ASK 11
For more information about The Ross Tilley Burn Centre, please call 416.480.6814 2075 Bayview Avenue - D7 Toronto ON M4N 3M5 PR 15060 June 2013