Achieving Patient-Centered Goals with Innovative Pouching Techniques

PURPOSE: This abstract provides an overview and description of a customized pouching technique developed for a patient with a complex, high output enterocutaneous fistula.

OBJECTIVES: Identify an effective patient management protocol by networking with other Wound, Ostomy, and Continence (WOC) nurses, considering tips from previously reported customized techniques, and creatively using available products that would achieve the following patient goals: (1) protect the perifistular skin integrity, (2) provide containment of effluent, (3) control odor, (4) allow accurate measurement of effluent, (5) allow mobility and comfort for the patient, and (6) decrease time spent in care.

OUTCOMES: The new application technique provided a comfortable pouching system with a wear time of five to seven days. Application time was decreased by over 30 minutes from other pouching techniques performed. Patient visits required for application were reduced to twice a week in an outpatient clinic setting. The patient was able to regain a productive and active lifestyle in which she resumed her exercise routine of walking up to two miles a day. The products used were comparable in cost, access, and easily customized for the patient.

DISCUSSION: WOCN states that involvement of nurses specializing in care of complex patients, such as those with enterocutaneous fistulas, can result in improved patient outcomes and cost savings for health care institutions. WOC nurses contribute to best practices by sharing their experiences of using properties and functions of products to customize treatments and successfully achieve patient-centered goals. The products used assisted in achieving both patient goals as well as the goals for nursing management of fistulas.

CONCLUSION: The procedure used has been further utilized to customize other pouching systems for patients with enterocutaneous fistula(s) as well as less than ideal ostomy stomas to achieve adequate wear time.