Practice Protocol : Management of Highoutput Ileostomy Patients from Hospital to Home

In 2014 the Division of Colorectal Surgery at our tertiary care medical center in the Northeast requested that a task force be assembled to address the problem of hospital readmissions, specifically the ileostomy patient suffering from dehydration. The task force was composed of the in-patient advanced practice nurse (APP), our team of hospital based WOC nurses, a nutritionist, and a newly appointed out-patient APP managing our ostomy services clinic. We completed a literature review and divided our work into the following major categories:

• Establishing a protocol for the medical management of the high output stoma patient.
• Developing an educational packet focused on post-operative nutrition and hydration.
• Designing an intake and output ( I&O) record for patient and staff use.
• Streamlining all WOC nursing documentation utilizing the electronic medical record.
• Strengthening our link to home care through care management providers.
• Utilizing the out-patient ostomy clinic to infuse our practice protocols through pre-operative patient education.

Our progress thus far includes: implementation of a medical management guideline outlining a stepwise approach to drug therapy for the high output ileostomy patient; and automatic scheduling of nutrition consults for all ileostomy patients intended to provide education on dehydration prevention. Furthermore, an I&O tool has been implemented on post op day 1 to involve the patient in self-monitoring of stoma output. Standardized “smart phrases” were created in the electronic record and  utilized by all WOC nurses making communication between providers clear and concise.

Progress is ongoing. Preoperative educational materials for the ostomy services clinic are in final development. The I&O tool is being evaluated for patient understanding and usefulness with a questionnaire. Formal in-service education for home care agencies will be provided after all elements of the protocol have been implemented. Data collection will begin in 2015 to evaluate our readmission rates.