Quality Improvement Project: Preoperative Stoma Marking and Education Protocol

Over one million people in the United States live with a permanent or temporary ostomy.¹  It is widely known patients who are provided with preoperative stoma site marking experience reduced pouch leakage, fitting challenges, and skin breakdown post-operatively.² Evidence supports preoperative stoma marking by a wound, ostomy and continence (WOC) nurse as a way to reduce post-operative complications, enhancing patient self-efficacy and quality of life.^3-5  Third quarter aggregate data (emergent and non-emergent surgeries) in 2016, at a Midwest, urban teaching hospital revealed only 23.8% of patients undergoing fecal or urinary diversion had preoperative stoma marking and education.  Numerous ostomy patients returned to the outpatient setting for complications related to stomal placement.  The proposed quality improvement project was aimed to increase the number of patient consults from surgeons to the WOC nurse for preoperative stoma marking and education.  Aggregate data (emergent and non-emergent surgeries) post quality improvement project revealed 31% of patients undergoing fecal or urinary diversion had consults to the WOC nurse for preoperative stoma marking and education in the first two quarters in 2017 and 50% in the third quarter, 2017.  For patients undergoing non-emergent ostomy surgery in the first three quarters of 2017, 70%, 100%, and 71% respectively, were referred to the WOC nurse for preoperative stoma marking and education. This quality improvement program encouraged collaboration between surgeons and the WOC nurse in increasing patient consults for preoperative stoma marking and education for persons undergoing fecal or urinary diversion surgery.