Empowering Nurses to Manage Ostomy Care for Patient Admitted With Ostomy

Background:

Patients with an ostomy admitted to our facility after the WOC nurse shift, challenged the RN to find the appropriate size and type of ostomy appliance.  Patient’s frequently do not bring their supplies to the hospital, or they use a product that is not on our formulary.  Nurses are usually unfamiliar with the vast number of available ostomy products.  Consequently they were unable to determine which supplies were needed to appropriately change the appliance.  Many times this would end with leakage problems and at times peristomal skin damage due to a poorly fitted appliance.  This resulted in decreased patient and family confidence.  The nurse became frustrated, embarrassed and experienced loss of valuable time.

Clinical Solution:

In evaluating the problem we developed an ostomy kit.  A plastic zip bag contained our Appliance Change Worksheet, a 2 ¾”  “cut to fit” wafer (fits most stomas), pouch, curved scissors, stoma paste, adhesive remover wipe, skin barrier wipe, measuring guide and end tail clip.   Our “Emergency Ostomy Kit” is stored in our Central Supply area.   At any time a nurse may call and request the kit.   Additionally a  sticker was placed on the outside of the packet telling the nurse which pouch to order if the patient had a urostomy, (ileal conduit) and information for placing a consult to the Wound Management Support Team.

Outcomes:

Our team assembles the kits as needed.  The kits are charged directly to the units.  We use about 20 a month, or 250 a year.  Nurses are appropriately using the kits and placing appliances on patients.  Nurses report satisfaction, empowerment and time savings.  The patients are comfortable, confident, and have decreased peristomal complications.  This process improvement immediately stopped the wasteful “trial and error” method requiring multiple supplies.