The WOCN role in dehydration prevention in ileostomy patients

The WOCN role in dehydration prevention in ileostomy patients. (Practice Innovations)

Purpose: To demonstrate the WOCN role in assessment, education and evaluation of the ileostomy patient’s risk of dehydration.

Objective: To prevent readmission with dehydration in ileostomy patients through collaboration of services, education of staff and patient and evaluating effectiveness of interventions from pre-op, hospitalization and post-op care.

Methodology:

The WOCN team observed readmissions of ileostomy patients with dehydration as demonstrated by their physical symptom including increased ostomy output greater than 1 liter, decrease in urine output, poor PO intake and weakness upon admission the ER. The WOCN team shared their concerns with the Colorectal Surgeons, nutrition and staff nurses once a trend was recognized and they collaborated to develop a dehydration prevention protocol and educational materials to prevent/limit readmissions. The WOCN initiated education to prevent readmissions. The medical team developed their role specific  protocols including strict I/Os, daily weights, defining high stoma output as >1000cc/24hrs, a KUB to r/o small bowel obstruction and med regimen including Imodium 2mg 30min prior to meals add Lomotil, tincture of opium and codeine. The WOCN role includes instructing patients on measuring and recording output, nutrition and fluid intake, recognizing signs and symptoms, and how to therapeutically manage high output at home.  Education included the staff nurse, outpatient nurse, nutritionist and social worker. Patients are discharged with a graduate container to measure and instructions of when to notify MD.

Results: A decrease in readmissions was recognized by MDs and WOCN therefore patients’ quality of life improved.

Conclusion: The WOCN initiation of this area of concern has assisted patients in improving their quality of life and stimulated medical research in this population.