Improving Ostomy Care in Our Smallest Patients

Improving Ostomy Care for Our Smallest Patients

Problem Statement: In a large tertiary-care setting, neonatal ostomy care presents on-going challenges for providers.  Limited product options, premature skin, and complex ostomy needs without a dedicated ostomy nurse resulted in significant skin breakdown. Without a comprehensive plan for this fragile population, the ability to grow, quality of life, pain management, supply costs, and caregiver time may be negatively affected. A need for an effective management plan was identified.       

Past Management:  Initially, the ostomy team was comprised of two fulltime CWOCN’s who provided care throughout the facility and across the lifespan.  While ostomy care was provided in the NICU when consults were received, often the team was sought out in response to a significant skin breakdown.    

Clinical Approach: With the addition of a third CWOCN to the team, an opportunity to improve care and develop a program was presented.  Increased rounding on patients in the NICU was provided on an almost daily basis, multiple patient specific bedside in-services were given and each patient had individualized picture instructions placed at the bedside.  In addition visual case studies were presented at skills day and relationships were built with the nursing staff.   

Outcomes:  Timely consults to the ostomy team have increased allowing for earlier implementation of care plans.  Increased rounding has been a key factor to making the changes needed to address skin issues early.    

Conclusions:  The ability to provide continuous, dedicated, proactive care to this extremely fragile population has resulted in improved quality of life and decreased the costs associated with significant peristomal skin breakdown.