6256 The Case for Preoperative Teaching and Stoma Marking in the General Surgery Population

Katherine M. Zimnicki, DNPc, ACNS-BC, CWOCN, Wayne State University, Henry Ford Health System, Clinical faculty and CNS, Detroit, MI
The use of evidence based practice (EBP) guidelines to guide and determine best practice is increasingly emphasized in the literature. EBP is an ongoing, problem solving approach to clinical practice integrating relevant research, evidence from quality improvement projects, clinical expertise of health care practitioners, desired patient outcomes, and patient preference and values. Preoperative teaching and marking has advocated to increase the chances of appropriate stoma location and independent  management of the ostomy. It forms the basis of recommendations by the Wound, Ostomy, Continence Nurses and other organizations to have all patients scheduled for a urinary or fecal diversion receive preoperative teaching and marking. Recent studies support these recommendations demonstrating a reduction in length of stay, time to reach independence, numbers of home care visits and product usage; as well as an increase in QOL indicators. Additionally, the Joint Commission‘s National Patient Safety Goals requires the marking of any surgical site when there is more than one possible location for the procedure and when performing the procedure in a different location could harm the patient. Anecdotally, many General Surgery patients fail to receive the recommended preoperative marking and teaching. Preliminary data of 30 General Surgery patients, obtained through a retrospective chart audit using convenience sampling, revealed only three (10%) received pre-operative marking or teaching.  Using the FOCUS-PDCA model of Total Quality Management a multidisciplinary team was formed with the objectives of developing and implementing a protocol designed to better identify patients who would benefit from preoperative marking and teaching, identify and educate appropriate personnel to perform these interventions in the absence of a CWOCN, and ultimately increase the number of General Surgery/Trauma Surgery patients appropriately identified, marked, and taught preoperatively. Implementation and evaluation of this process improvement is planned for January to April of 2012.