Development of a multidiscplinary team to prevent peristomal hernia

Topic: Peristomal hernia (PH) is a pervasive, costly, and distressing problem for persons living with permanent ostomies. Prevalence rates vary greatly ranging from 20% to 78% of patients.  Persons with PH experience difficulties with pouch adherence, leakage, increased use of supplies and reduced quality of life.  At times, it may be difficult to conceal the peristomal bulge making it difficult to find properly fitting clothing.  More severe problems such as bowel strangulation, perforation and obstruction can be life threatening.

Risk factors for developing PH include: type of diversion, size of the opening in the abdominal rectus muscle, age, weakness of the abdominal wall musculature, excessive coughing or vomiting, steroid use, intra-abdominal tumor growth, emergency placement, smoking and obesity.

PH may not be completely preventable. Nevertheless, available research suggests early introduction of a support garment and an appropriately focused exercise and proper body mechanics education program can help prevent development of a PH (North, 2014; Thompson & Trainor, 2005). In addition, research has made it clear that optimal outcomes with respect to improved quality of life and decreased prevalence of PH depend upon patient adherence to garment use, exercise and proper body mechanics recommendations.

Objective:

To develop an interdisciplinary hernia prevention pathway for persons undergoing permanent ostomy surgery.

Purpose:  to develop and implement a formalized multidisciplinary program to promote adherence to hernia prevention self-care practices, and  decrease the prevalence of PH among patients undergoing permanent ostomy surgery for cancer or inflammatory bowel disease.  This program, directed by a certified wound, ostomy, and continence (WOC) nurse practitioner includes risk screening, comprehensive education from a physical therapist specially trained in pelvic floor rehabilitation, and support garment recommendations. 

Outcome:  Our interdisciplinary hernia prevention pathway demonstrates flow process, points of contact with the patient, and discipline-specific interactions expected at each point of contact.