Debra Johnston, MN, RN, CETN(C), Wound and Ostomy, Toronto General Hospital, Toronto, ON, Canada, Debbie Miller, MN, RN, CETN(C), Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada, Marg McKenzie, RN, CCRP, Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada and Monica Frecea, MScN, RN, CETN(C), Enterostomal Therapy, Mount Sinai Hospital, Toronto, ON, Canada
Enhanced Recovery After Surgery (ERAS) is a multimodal program developed to decrease postoperative complications, enhance recovery and promote early discharge. In the province of Ontario, Canada, a standardized approach to the care of patients undergoing colorectal surgery was adopted by 15 hospitals in March 2013. All elective colorectal surgery patients with or without an ostomy were included in the ERAS program targeting a length of stay of 3 days for colon surgery and 4 days for rectal surgery. It was important to ensure that the individual needs of patients requiring an ostomy were being met within this new health care delivery model given that ERAS was becoming the standard of care. Different providers with varying levels of experience and expertise were caring for this vulnerable patient population and there was variation in the support available and offered to patients following their acute care discharge.
The strategy to meet the patient care need has been two-fold. First, a provincial ERAS Enterostomal Therapy Nurse (ETN) Network was established, which developed an evidence-based ostomy specific clinical practice guideline for ERAS patients requiring a fecal diversion. The second phase has been the individualized implementation of this robust clinical guideline by each ERAS hospital and associated community care provider grounded within the distinctive available resources in their area utilizing a standardized approach.
This presentation provides participants with an overview of the work accomplished by this group over a 3-year period. The established clinical recommendations to standardize the nursing care of patients with an ostomy within the preoperative, postoperative and discharge phases will be presented. The innovative ERAS ETN implementation strategies to garner interest and secure organizational support and commitment will be discussed. In addition, quality indicators will be highlighted as they will be utilized in future to evaluate the success and effectiveness of this initiative.
![[ Visit WOCN Website ]](images/banner.jpg)