CONSISTENCY ACROSS THE CONTINUUM: A system wide approach to the management of challenging enterocutaneous fistulae

Management of complex enterocutaneous fistulae occupies a significant amount of time for the WOC team in an acute care, tertiary Level I trauma center.  These patients experience prolonged, costly length of stay which involve complicated containment systems, nutrition and hydration management.  Discharge planning requires a multidisciplinary approach of the WOC Nurse, physician, nutritionist, case manager, and patient’s caregiver, home care agency and the primary nurse. Consistent pouch wear time has been a barrier to discharge to other care settings for many of these patients.

Consistent implementation of a management plan between caregivers has proven to be a challenge despite significant time spent on staff education by the WOC Nurses.  Small variations in technique often mean the difference between adequate wear time and leakage with associated skin breakdown. Since WOCN nursing staff is not available at all times, it is important for the bedside nurse to be able to change and manage the appliance according to the individualized procedure that has been developed.

A standardized documentation form was developed with supply list and step by step instructions. In addition the use of a photo documentation guide for the step-by-step procedure was implemented very successfully.  This information follows the patient to different care settings and has been effective in easing the transition out of acute care. Communication with the receiving agency prior to transfer ensures ability to implement the plan and availability of supplies.   It has also decreased time and calls for the WOC Nurse related to patient management.  This practice has been implemented with all fistula patients, with resulting continuity of care, decreased time and costs for the facility and increased patient and caregiver satisfaction.