A Multidisciplinary Approach to Ensuring Pre-operative Stoma Site Marking and Education of Elective Colostomy, Ileostomy and Urostomy Patients.

Abstract: Ongoing discussions with colorectal and urological surgeons regarding the importance of referring patients for pre-op stoma siting and education has not resulted in capturing most of the elective colostomy, ileostomy and urostomy patients for pre-operative stoma site marking and education. 

Purpose & Rationale:  It is well documented in the literature that pre-operative teaching and stoma site marking improves patients’ quality of life, promotes independence, self-care efficacy and reduces the rates of post-operative complications.  A standard work process that is consistent and structured will provide guidance to nursing and administrative staff to ensure capturing all elective urostomy, colostomy and ileostomy patients.

Research Questions: Does a structured multidisciplinary process improve the rate of pre-operative stoma site marking for elective colostomy, ileostomy and urostomy patients?

Synthesis of Review of Literature : Current literature review supports the need for pre-operative stoma site marking for all patients undergoing elective colostomy, ileostomy and urostomy surgery.

Methods/Procedures: A standard work process was developed in the Pre-Assessment Center to identify all elective patients being scheduled for  ostomy surgery.  These patients are scheduled for pre-operative teaching and stoma site marking. An electronic scheduling process was developed between the PAC and the Ostomy Specialists to ensure WOCN availability.

The rate of stoma site marking for all elective patients undergoing colostomy, ileostomy and urostomy surgery was calculated for 2017 and 2018. 

Results: Pending 

Discussion/Application to Practice: Decreasing LOS, ERAS protocols, and inpatient staffing constraints necessitate that the ostomy patient has stoma site marking and receives as much information and teaching pre-operatively by an ostomy specialist.  An appropriate stoma site can decrease ostomy-related complications such as leakage and peristomal dermatitis.  Decreased ostomy complications can potentially decrease the amount of ER visits for ostomy-related issues. Pre-operative education allows for a patient-centered approach that incorporates the patient’s individual needs, preferences and value system.