Facilitating the Transfer of Expert Knowledge and Practice in Complex Stoma Care using the 3 C's: Consulting, Collaborating, and Coaching

Background:  Skin irritation and leakage are reported as common problems contributing to decreased adherence of ostomy appliances.  This negatively impacts ostomy patient’s overall quality of life.  Problem identification and timely intervention facilitates discharge, prevents readmission, and improves quality of life for the ostomy patient. 

Description: A 300+ bed hospital experienced expansion of general surgery cases.  Expansion increased fecal/urinary diversions.  Cases were complicated, requiring complex stoma care interventions not easily communicated in writing.  CNS Educators were challenged to establish innovative approaches consistently communicating interventions to nursing staff and patient/family.  CNS consulted CWOCN Specialist to establish individualized plans for each patient.  This lead to a project focused on creation of individualized photographic tutorials as clinically efficacious coaching tools used to promote continuity/consistency among caregivers while improving patient satisfaction. With patient consent digital photographs were taken to illustrate stoma care.  Tutorials were organized in PowerPoint format, step-by-step bulleted directions of care.  Plan was devised, stoma care photographed, tutorials provided to the patient and interdisciplinary team.

Outcome: This creative and innovative approach to communicating complex stoma care proved a valuable coaching tool.  Collaboration of the CNS, CWOCN, Clinical RN, Care Manager, and Patient/family optimized clinical outcomes for the ostomy patient.  The evidence-based tutorials were developed through consultation with CWOCN and proved instrumental in preventing hospital re-admission, decreasing length of stay, and facilitated transfer to rehab and home health agencies.  Through Consultation, collaboration, and coaching the CNS lead clinical project positively impacted the ostomate and family/caregiver progress towards independent stoma care.