Implementation of Evidenced Based Practice: A Collaborative Approach to Discharge of Patients with a New Fecal Ostomy

Objectives: (1) To align current practices to the WOCN best practice for clinicians: "Discharge Planning for Patient with Ostomy” (2). To assist with transition of care across the healthcare system/continuum. 

A review demonstrated wide variation in practice between surgical services regarding discharge planning for patients undergoing surgery resulting in the creation of a fecal ostomy including inconsistent links to home health care.  The literature clearly demonstrates the standards of care for patients with a new fecal ostomy including a comprehensive discharge plan.  A collaborative team including WOC nurses, home care nursing, nurse practitioners, case management, and staff surgeons verified the variations in practice and identified gaps. Using the WOCN Society’s best practice guidelines a process was developed to improve the discharge and follow up process for new ostomates through: (1) Streamlined patient educational materials (2) Establishment of a relationship with home healthcare providers  (3)  Development of consistent practice guidelines for use across surgical sub-specialties (4) Consistent outpatient ostomy follow up opportunities  and (5) Assistance with obtaining ostomy supplies at discharge. Together, a process was developed that provides the framework to allow providers to deliver consistent and individualized care to the patient with a new fecal ostomy that meets care outcomes and assists with the transition from the inpatient to outpatient setting.

Outcome:  The process developed by stakeholders from multiple disciplines demonstrates the opportunities for process improvement teams to improve patient outcomes with evidence based interventions. Additionally, it provides the framework for future collaborations designed to improve the processes for pre and post-operative care of the individual with a fecal or urinary ostomy.