J Wound Ostomy Continence Nurs. 2014;41(3):206-207. Published by Lippincott Williams & Wilkins
CAET FEATURE
Preoperative Ostomy Education and Stoma Site Marking Kathryn Kozell
P
Monica Frecea
Julie Tjan Thomas
reoperative preparation of patients for ostomy surgery has been linked to a reduced likelihood of ostomyrelated complications, better patient acceptance of the stoma, and positive long-term outcomes.1-3 As enterostomal therapy nurses (ETN), the role of providing preoperative ostomy education and determining the best site for abdominal stoma placement is well recognized.4 As members of the Centre of Excellence for Inflammatory Bowel Disease within an academic health care center, our enterostomal therapy nursing team was challenged to examine the qualitative manner in which ostomy care was being delivered. Traditionally and from a system perspective, preoperative ostomy education and stoma site marking have been provided by the ETN Monday to Friday during daytime hours. Preparation of patients and their families undergoing elective and urgent consults is conducted in various locations such as the surgical preadmission unit, the enterostomal therapy nursing outpatient clinic, the inpatient units, surgeons’ clinics, the emergency department, the intensive care unit, and the operating room. Over the past 3 years, the number of patients being admitted for ostomy surgery has increased from 300 to 381 with an additional increase anticipated in 2014. Despite the ETN team’s attempts to provide preoperative consultation for all patients, in reality a significant gap in care delivery was demonstrated. This gap represented 12% or approximately 45 patients per year who were missed and therefore not provided preoperative ostomy education and stoma site marking. Further investigation identified that the majority of patients missed occurred during evenings, nights, weekends, and holiday periods, times when the ETN team was not available to provide this care. In 2011, the Best Practice Ostomy Team (BPOT), whose membership is composed of 8 RNs and 3 advance practice nurses who are certified in enterostomal therapy, was initiated. The mandate of BPOT is to ensure that the standard of ostomy care excellence is maintained through the implementation of best practice recommendations for ostomy care and management published by the Registered Nurses Association of Ontario.5 Collectively, a major objective was determined to ensure that 100% of patients and their
206 J WOCN ■ May/June 2014
families undergoing surgery for possible or elective ostomy surgery will receive preoperative ostomy education and stoma site marking. This bold undertaking led to the establishment of the Preoperative Ostomy Resource Team (PORT). Ten RNs from the Preadmission Clinic and Inflammatory Bowel Disease and Surgical Gastrointestinal/Oncology units volunteered to become PORT members (Figure 1). Following 8 hours of theoretical preparation and 4 hours of clinical competency
FIGURE 1. Members of the Preoperative Ostomy Resource
Team. Kathryn Kozell, RN, MScN, CETN(C), Clinical Nurse Specialist and Manager, Rachel Flood Education Program, Mount Sinai Hospital, Toronto, Ontario, Canada. Monica Frecea, RN, MScN, CETN(C), Clinical Nurse Specialist and Manager, Enterostomal Therapy Program, Mount Sinai Hospital, Toronto, Ontario, Canada. Julie Tjan-Thomas, RN, MN, CETN(C), Clinical Nurse Specialist and Manager, Enterostomal Therapy Program, Mount Sinai Hospital, Toronto, Ontario, Canada. The authors declare no conflicts of interest. Correspondence: Monica Frecea, RN, MScN, CETN(C), Mount Sinai Hospital, 600 University Ave, Rm 1401, Toronto, ON , M5G 1×5, Canada ([email protected]). DOI: 10.1097/WON.0000000000000031
Copyright © 2014 by the Wound, Ostomy and Continence Nurses Society™
Copyright © 2014 Wound, Ostomy and Continence Nurses Society™. Unauthorized reproduction of this article is prohibited.
JWOCN-D-14-00025.indd 206
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J WOCN ■ Volume 41/Number 3
Kozell et al
TABLE 1.
Total Number of Preadmission Ostomy Consults Per Year
Year
Total Number of Preoperative Ostomy Consults
Number of Missed Patients
2010
325
…
2011
380
45
2012
381
2
2013
411
0
development, and with the support of senior nursing leaders, the gastrointestinal surgeons, and nursing colleagues, PORT was formally launched in May 2012. In the absence of the ETN team, PORT was consulted and within the first month of implementation the gap was closed. The PORT team continues to demonstrate its important role in providing preoperative ostomy preparation in collaboration with the ETNs. After its first year of operation (May 2012–December 2012), only 2 patients were missed, and at the end of 2013 our goal was achieved—all patients scheduled for ostomy surgery received preoperative ostomy education and stoma site marking (Table 1).
207
Moving from a system delivery care approach to a patient-/family-centered care value enabled us to refocus our resources in providing the best care possible. Both the ETNs and PORT members have enhanced the preoperative experience for better outcomes for our patients and have developed a collaborative relationship that emulates the best in professional nursing practice.
■ References 1. Park JJ, Del PA, Orsay CP, et al. Stoma complications: The Cook County Hospital experience. Dis Colon Rectum. 1999;42(12): 1575-1580. 2. Haugen V, Bliss DZ, Savik K. Perioperative factors that affect long-term adjustment to an incontinent ostomy. J Wound Ostomy Continence Nurs. 2006;3(5):525-535. 3. Chauduri S, Brown L, Hassan I, Horgan AF. Preoperative intensive, community-based vs traditional stoma education: a randomized, controlled trial. Dis Colon Rectum. 2005;48(3): 504-509. 4. Wound Ostomy and Continence Nurses Society ASCRS and WOCN joint position statement on the value of preoperative stoma marking for patients undergoing fecal ostomy surgery. J Wound Ostomy Continence Nurs. 2007;34(6):627-628. 5. Registered Nurses Association of Ontario. Best Practice Guidelines for Ostomy Care and Management. Toronto, ON, Canada; 2009 ; 26-27 . http://rnao.ca/bpg/guidelines/ostomy-caremanagement. Accessed January 19, 2014.
Copyright © 2014 by the Wound, Ostomy and Continence Nurses Society™
J WOCN
■ May/June 2014 207
Copyright © 2014 Wound, Ostomy and Continence Nurses Society™. Unauthorized reproduction of this article is prohibited.
JWOCN-D-14-00025.indd 207
4/28/14 7:19 AM
CAET FEATURE
Preoperative Ostomy Education and Stoma Site Marking Kathryn Kozell
P
Monica Frecea
Julie Tjan Thomas
reoperative preparation of patients for ostomy surgery has been linked to a reduced likelihood of ostomyrelated complications, better patient acceptance of the stoma, and positive long-term outcomes.1-3 As enterostomal therapy nurses (ETN), the role of providing preoperative ostomy education and determining the best site for abdominal stoma placement is well recognized.4 As members of the Centre of Excellence for Inflammatory Bowel Disease within an academic health care center, our enterostomal therapy nursing team was challenged to examine the qualitative manner in which ostomy care was being delivered. Traditionally and from a system perspective, preoperative ostomy education and stoma site marking have been provided by the ETN Monday to Friday during daytime hours. Preparation of patients and their families undergoing elective and urgent consults is conducted in various locations such as the surgical preadmission unit, the enterostomal therapy nursing outpatient clinic, the inpatient units, surgeons’ clinics, the emergency department, the intensive care unit, and the operating room. Over the past 3 years, the number of patients being admitted for ostomy surgery has increased from 300 to 381 with an additional increase anticipated in 2014. Despite the ETN team’s attempts to provide preoperative consultation for all patients, in reality a significant gap in care delivery was demonstrated. This gap represented 12% or approximately 45 patients per year who were missed and therefore not provided preoperative ostomy education and stoma site marking. Further investigation identified that the majority of patients missed occurred during evenings, nights, weekends, and holiday periods, times when the ETN team was not available to provide this care. In 2011, the Best Practice Ostomy Team (BPOT), whose membership is composed of 8 RNs and 3 advance practice nurses who are certified in enterostomal therapy, was initiated. The mandate of BPOT is to ensure that the standard of ostomy care excellence is maintained through the implementation of best practice recommendations for ostomy care and management published by the Registered Nurses Association of Ontario.5 Collectively, a major objective was determined to ensure that 100% of patients and their
206 J WOCN ■ May/June 2014
families undergoing surgery for possible or elective ostomy surgery will receive preoperative ostomy education and stoma site marking. This bold undertaking led to the establishment of the Preoperative Ostomy Resource Team (PORT). Ten RNs from the Preadmission Clinic and Inflammatory Bowel Disease and Surgical Gastrointestinal/Oncology units volunteered to become PORT members (Figure 1). Following 8 hours of theoretical preparation and 4 hours of clinical competency
FIGURE 1. Members of the Preoperative Ostomy Resource
Team. Kathryn Kozell, RN, MScN, CETN(C), Clinical Nurse Specialist and Manager, Rachel Flood Education Program, Mount Sinai Hospital, Toronto, Ontario, Canada. Monica Frecea, RN, MScN, CETN(C), Clinical Nurse Specialist and Manager, Enterostomal Therapy Program, Mount Sinai Hospital, Toronto, Ontario, Canada. Julie Tjan-Thomas, RN, MN, CETN(C), Clinical Nurse Specialist and Manager, Enterostomal Therapy Program, Mount Sinai Hospital, Toronto, Ontario, Canada. The authors declare no conflicts of interest. Correspondence: Monica Frecea, RN, MScN, CETN(C), Mount Sinai Hospital, 600 University Ave, Rm 1401, Toronto, ON , M5G 1×5, Canada ([email protected]). DOI: 10.1097/WON.0000000000000031
Copyright © 2014 by the Wound, Ostomy and Continence Nurses Society™
Copyright © 2014 Wound, Ostomy and Continence Nurses Society™. Unauthorized reproduction of this article is prohibited.
JWOCN-D-14-00025.indd 206
4/28/14 7:19 AM
J WOCN ■ Volume 41/Number 3
Kozell et al
TABLE 1.
Total Number of Preadmission Ostomy Consults Per Year
Year
Total Number of Preoperative Ostomy Consults
Number of Missed Patients
2010
325
…
2011
380
45
2012
381
2
2013
411
0
development, and with the support of senior nursing leaders, the gastrointestinal surgeons, and nursing colleagues, PORT was formally launched in May 2012. In the absence of the ETN team, PORT was consulted and within the first month of implementation the gap was closed. The PORT team continues to demonstrate its important role in providing preoperative ostomy preparation in collaboration with the ETNs. After its first year of operation (May 2012–December 2012), only 2 patients were missed, and at the end of 2013 our goal was achieved—all patients scheduled for ostomy surgery received preoperative ostomy education and stoma site marking (Table 1).
207
Moving from a system delivery care approach to a patient-/family-centered care value enabled us to refocus our resources in providing the best care possible. Both the ETNs and PORT members have enhanced the preoperative experience for better outcomes for our patients and have developed a collaborative relationship that emulates the best in professional nursing practice.
■ References 1. Park JJ, Del PA, Orsay CP, et al. Stoma complications: The Cook County Hospital experience. Dis Colon Rectum. 1999;42(12): 1575-1580. 2. Haugen V, Bliss DZ, Savik K. Perioperative factors that affect long-term adjustment to an incontinent ostomy. J Wound Ostomy Continence Nurs. 2006;3(5):525-535. 3. Chauduri S, Brown L, Hassan I, Horgan AF. Preoperative intensive, community-based vs traditional stoma education: a randomized, controlled trial. Dis Colon Rectum. 2005;48(3): 504-509. 4. Wound Ostomy and Continence Nurses Society ASCRS and WOCN joint position statement on the value of preoperative stoma marking for patients undergoing fecal ostomy surgery. J Wound Ostomy Continence Nurs. 2007;34(6):627-628. 5. Registered Nurses Association of Ontario. Best Practice Guidelines for Ostomy Care and Management. Toronto, ON, Canada; 2009 ; 26-27 . http://rnao.ca/bpg/guidelines/ostomy-caremanagement. Accessed January 19, 2014.
Copyright © 2014 by the Wound, Ostomy and Continence Nurses Society™
J WOCN
■ May/June 2014 207
Copyright © 2014 Wound, Ostomy and Continence Nurses Society™. Unauthorized reproduction of this article is prohibited.
JWOCN-D-14-00025.indd 207
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