Are you perplexed? Go to convex!

Jessica Lieder, MSN, APRN, ANP-BC, IIWCC-NYU, Elizabeth Savage, MSN, APRN, ACNS-BC, CWON and Sarah Lebovits, RN, MSN, ANP-BC, CWOCN, DAPWCA, IIWCC-NYU, Wound & Ostomy Program, NYU Langone Medical Center, New York, NY
Purpose/Objective: At a large magnet academic medical center in Metropolitan New York City, the Wound & Ostomy Program noted frequent postoperative conversion to convexity within the first month with a large volume of visits to the clinic. Patients were experiencing leakage and/or poor appliance weartime and resultant peristomal chemical irritant dermatitis necessitating a conversion to convexity. The Wound & Ostomy Program advanced practice nurses (APNs) sought a solution. A review of the literature showed limited evidence for the routine use of convexity postoperatively to reduce postoperative pouch changes as well as leakage. The APNs decided to trial using soft convexity as the standard of care versus flat pouching systems for postoperative ostomy patients as long as not contraindicated  (e.g. patient preference, product availability) to decrease outpatient clinic visits and postoperative pouch changes to convexity.

Outcomes: After conversion to soft convexity rather than a flat pouch as the standard of care initially postoperatively, a significant decrease in postoperative visits to the outpatient clinic for peristomal chemical irritant dermatitis in the setting of leakage and poor appliance weartime was noted. A decrease in patient reported dissatisfaction with postoperative management as as secondary outcome was identified.