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"Walking together in kindness" artwork produced for Gold Coast Health by Riki Salam, We are 27 Creative.
For nearly a decade, Tracey Hunt has been involved in research that is changing how healthcare systems around the world understand and manage wounds that occur at the end of life.
The journey began in 2017 when Tracey, a Clinical Nurse Consultant and Patient Safety and Quality Coordinator, was reviewing a pressure wound in a palliative care patient.
During her review, a nurse suggested the wound was a “Kennedy ulcer”, which was a term Tracey had never encountered.
"I started Googling, as you do, and I couldn't find much," she said.
What she discovered when she delved deeper into the topic was a significant gap in global knowledge.
There was little evidence, no consistent terminology and no agreed way of identifying wounds that develop as part of the dying process.
Working with researchers from Griffith University and collaborators across Australia and internationally, Tracey helped launch a research program to better understand these wounds and distinguish them from preventable pressure injuries.
The team's research identified that some wounds could occur when a person's skin begins to fail as part of the body's natural decline toward death.
"We have all these tests that tell us the heart or kidneys are dying, but it’s hard to know when the skin is dying," she said.
"A terminal ulcer is unavoidable, and that's the important distinction our research set out to demonstrate.
"When the patient is dying, the skin stops healing itself, and can break down suddenly."
The findings challenge the long-held assumption that all severe pressure wounds are preventable and have led to the development of internationally recognised definitions, assessment criteria and screening tools for what are now increasingly referred to as end-of-life wounds.
The impact has extended well beyond Gold Coast Hospital and Health Service. The research informing international policy discussions and contributing to changes in the United States, where approaches to the management of end-of-life wounds in aged care settings have evolved.
One of the most important outcomes, according to Tracey, is the support it provides clinicians caring for patients in their final days.
The work is now helping inform discussions about international disease classification codes for skin failure and end-of-life wounds, a milestone that could further improve patient care.
Reflecting on the nearly 10-year journey, Tracey remains focused on the difference the groundbreaking research can make for patients, families and healthcare workers.
