Ostomy Pouch Tail Closure Quality Improvement Project

CWOCN's received complaints from patients and RN's caring for patients with ileostomies and colostomies that the tail closure of the pouch was difficult to open, close, and clean effectively when teaching patients. Patients cannot open the tail closure by pinching the sides and have to use a finger to force it open. When the tail closure cannot be thoroughly cleaned, it may cause fecal odor and stool could leak out.  There were no problems with the technique being used to open, close, and clean the tail closure of the pouches. It was identified as a manufacturer quality control issue. CWOCN's decided to trial the manufacturers updated tail closure. An evaluation was planned, presented to the products committee, and approved.  The manufacturer agreed to provide one box of the new pouches for each ostomy patient enrolled in the trial for a month. Prior to the trial, a survey monkey was sent to all of the registered nurses and patient care assistants on the colorectal surgery floor to obtain objective data about the current pouch. The new pouch was then inserviced by the sales representative to all shifts of RN's and PCA's. The trial pouch was delivered to the patients by the CWOCN's during the post-operative visit. RN's and PCA's evaluated the new tail closure with fifteen patients whose average length of stay is five days. The majority of the patients had a new ileostomy which provided the staff with many opportunities to use and evaluate the tail closure. A post-trial survey monkey was e-mailed to the staff of the colorectal surgery unit. Based on the positive feedback, the CWOCN's presented the data and recommendation to change to the improved pouch to the products committee and it was approved. The old inventory was replaced with the new pouch for inpatients.