I'm No Longer a Grouch, I Have the Right Pouch Modification of an Ostomy Formulary

PURPOSE: To evaluate an existing ostomy product formulary.  PROBLEM: A healthcare network with an accredited trauma center and inpatient acute rehab was caring for multiple patients with complex ostomies as well as an increase in ileal conduit surgeries.  The existing ostomy formulary was not meeting the needs of the patients or the staff.  The following problems were identified: a large variety of two-piece pouching systems, lack of a variety of one-piece and urostomy pouches, inflexibility of two-piece pouching systems which led to leaking and skin irritation, inconsistent stocking of supplies on the nursing units which led to inappropriate use of products, and excessive wait time for special order products which lead to patients being discharged prior to being placed in the correct pouch.  METHOD: The current healthcare network ostomy contract was up for renewal which prompted the Wound Ostomy Nurses to meet and discuss an ideal formulary and evaluate products from different companies.  A formulary was selected based on the types of patients with ostomies that were evaluated by the Wound Ostomy Nurses.  The Wound Ostomy Nurses worked in collaboration with the store room to decrease products that were unnecessary for the inpatient population while adding products that were needed and often special ordered.  RESULTS: This formulary was presented to the Nursing Value Analysis committee and was approved.  Consults for peristomal skin irritation have decreased which led to an increase in patient and staff satisfaction.  Lastly, there has not been a need to special order any products.  CONCLUSION: The hospital did not have a contract with the selected company, but the clinical expert opinion and facts presented to the Nursing Value Analysis Committee was valued and ultimately led to a positive cost savings.  The role of a Wound Ostomy Nurse in an organization proves to be beneficial in affecting change.