"Avoid the Cracks": Enhanced Communication Across the Disciplines as part of the WOC Nurse Pre operative preparation of the client with a Total Pelvic Exenteration

Purpose

An ambulatory WOC Nurse examined the preoperative work flow of clients undergoing total pelvic exenteration. The standard of care at this institution is for clients to be seen preoperatively for Stoma Site Marking.  However, due to the complexity of this type of surgery, coordination of the WOC nurse visit along with GYN, Colorectal, Urology, and Plastics was not always in the correct sequence for the WOC Nurse to maximize the preoperative visit.  The challenge was the administrative staff doing the scheduling did not understand the difference between this and a regular stoma site marking visit. The WOC nurse decided to educate them about this surgery and develop a work flow where the WOC nurse would be last after all the multiple consents were signed.

Objective

Previously a total pelvic exenteration case was sometimes scheduled with 2 WOC nurses as 2 separate 45 min Stoma Site Marking visits. The WOC nurse met with an administrative supervisor and worked on this work flow to avoid a client potentially missing a WOC nurse visit as some patients left the clinic after the first marking. Education about the surgery was provided to the administrative staff and nurses.  The visit time is 90 mins, and only 1 ambulatory WOC nurse sees the client after all consents are signed to do the marking and education for 2 stomas, or a stoma and continent urinary diversion.  When the term total pelvic exenteration is placed on the surgical list the ambulatory WOC nurses are notified. This allows time for communication with the MDs about special circumstances (as these markings are not always standard).

Outcome

The process has improved and the WOC Nurses have been actively involved and aware of these cases much earlier than before this implementation.