Development of the Ostomy Outcome Risk Assessment Scale and the Ostomy Outcome Classification Index

Complications following intestinal diversional (ostomy) surgeries are a significant problem to many individuals. It has been estimated that up to 70% of patients with an ileostomy and 43% of those with a colostomy experience complications. Development of a scale that accurately predicts ostomy complications will enable clinicians to screen patients for the presence of risk factors prior to discharge and develop appropriate interventions. Purpose/Aim: The purpose of this study was to develop two reliable and valid instruments; 1) to assess risk of development of ostomy complications in the 30 day post-operative period and 2)to identify and classify ostomy-related complications in the 30 day post-operative period. Method/Design: This pilot study is comprised of two phases. In Phase 1, 14 items for the Ostomy Outcomes Risk Assessment Scale and 9 items for the Ostomy Outcomes Classification Index were generated from a review of the research and clinical literature on risk factors and ostomy complications. Content validity was established using a panel of ten Wound, Ostomy, Continence (WOC) nurse experts. In Phase 2, the OORAS and the OOCI instrument was pilot-tested using a convenience sample of 5 subjects recruited from one acute care setting. Results: The total content validity index (CVI) of the OORAS was 0.9. 12 of the 14 item CVI scores ranged from 0.9-1.0. 2 items scored 0.6 (smoking and diagnosis). In addition, the reviewers ranked the OORAS items in the order of importance. The top 3 items were stoma/abdomen characteristics, stoma site marked, and type of effluent. The total CVI score for the OOCI was 0.91. All nine individual item CVI scores of the OOCI were acceptable, ranging form 0.88-1.0. 5 subjects with a newly formed ostomy were assessed using the OORAS prior to discharge from the hospital and then 30 days post discharge using the OOCI. Pilot findings will be presented. Conclusion: The OORAS and the OOCI instruments both demonstrated that they were reliable and valid measures of ostomy risk factors and ostomy-related complications. The development of 2 valid and reliable instruments related to ostomy complications provides the clinician with additional resources to develop appropriate interventions to decrease ostomy complication severity.