Topic:  Patients with fistulas are often isolated for prolonged periods of time while hospitalized.  The stress this causes is compounded by the more unpleasant symptoms associated with their diagnosis such as malodorous drainage, skin breakdown, chronic pain and other burdens.  Current treatments are focused primarily on symptom management and may sometimes fail to address the personal and psychosocial needs of the patient, which may adversely impact treatment outcomes. 

Purpose:   Improve the outcomes and quality of life for patients with complex enterocutaneous fistulas by utilizing a multidisciplinary approach to innovative care that  addresses the patient's social, spiritual, educational and psychological needs, particularly when hospitalized for extended periods of time.

Objectives:  Reduce patient isolation and improve mental well being by incorporating activities, educational materials and adjunct therapies into traditional symptom management.

Outcomes:  A Fistula Task Force for Quality of Life was implemented in September 2007.  The task force includes staff nurses, nurse techs, Wound, Ostomy, Continences (WOC) nurses, Nutrition Support Team, Social Services, a research nurse and the Palliative Care team. The Task Force has provided patients with casual activities and games and is evaluating future email access, a possible media center, the implementation of flower, music, and recreational therapies to further enhance the patient's quality of life.  Odor eliminating products were evaluated by patients and staff to reduce odor and are now being utilized.  The WOC nurses have started using Negative Pressure Therapy with gauze dressings to provide suction for drainage, wound healing and portability.  This therapy allows greater mobility than traditional therapies. It has allowed for quicker discharges.  Spiritual and supportive needs for the patient and their families are also being addressed.  Lastly, an educational pamphlet is being developed for patients and their families about fistulas and their care.