Purpose: to develop a classification tool that quantifies ease or difficulty of abdominal stoma management.

Objectives: To incorporate stoma conditions and management outcomes into a tool that indicates the ease or difficulty of abdominal stoma management by patients.

To explore the utility of a management ease classification in communication between clinicians and sites of care.

Discussion:

Ostomy patients vary in degree of ease with which they manage their stomas. Many variables such as functional abilities, general health and strength, social support, cognitive skills, and resources affect the outcome of resuming a former life-style. A secure pouch is vital. The pouch system must remain leak free for a predictable length of time (WOCN, 2005). Other variables in the quest for a secure pouch are stoma location, stoma construction, and type of effluent.

As patients move through the system from acute to community care, between physician office, long-term care, hospital and home care, there is a need to communicate the complexity of needs to the next site of care.

A tool that described the degree of ease or complexity also defines the choice of health professional best qualified to provide care. Discharge planning should consider next site-of-care expertise that is needed to continue the plan of care. Patient or family given expert instruction in the hospital can manage stable new ostomy situations. Due to short LOS, expertise in ostomy management may be needed post-discharge to address ongoing or evolving problems with pouch security. Support can be achieved with outpatient clinics, home care, and long-term care through collaboration between the hospital WOC/ET nurse and next site of care.

Outcome:

A four category classification was devised that incorporates stoma construction, peristomal skin condition, effluent type, pouch change frequency and suggests next site care giver skill required to return the patient to pre-surgical life style.