Challenges and Opportunities Associated with Caring for Ostomy Patients in the Community

Health care delivery systems in the United States are complex. Acute care, long term care, home health care, long term acute care, skilled nursing care are acronyms for care delivery systems in place. Yet, as diverse as these are, none address the needs of the ostomy patient who encounters difficulty when discharged from these services. A 6 Sigma Lean analysis of the problem revealed that the health care infrastructure, as it existed, had no readily available structure in place to address the needs of this community population. Therefore a small group of ostomy nurses sought to develop a systematic approach to reach this vulnerable group. The nurses identified several areas of concern relative to this group: lack of resources within the community, limited economic resources, and insurance coverage.  The community involved has in place several not-for-profit community hospitals, who in their vision statement mention providing care to the community in which they exist. This served to be the vision which linked the ostomy nurses with the hospital system. The nurses then developed a framework wherein ostomy patients could confidentially be seen by a certified ostomy nurse, ask questions, and receive a stomal assessment and referrals as appropriate. A facilitator was identified in the group and then sought out a “change agent” among hospital administration. Through these efforts, involving clear communication, approval was given to establish “Ask an Ostomy Nurse”, a free service. This program has the support of a not-for-profit community hospital, product vendors, and local ostomy nurses. This joint venture to deliver care allows both groups to meet their vision, and can best be summarized by Pauline R.  Kezer’s statement that “Continuity gives us roots; change gives us branches, letting us stretch and grow and reach new heights”.