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Ostomy Care
The skin around the stoma needs to stay healthy and free of irritation. Proper skin barrier use and pouch application will help prevent swelling, redness, or rash.
Who is Really Providing Ostomy Care Today?
"The home care agency didn't have an ET Nurse." "I never saw an ostomy nurse." The numbers don't add up.
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A Retrospective
Unlike many other surgery patients, people with ostomies do not walk away “all better. Specific patient issues also are regularly considered, including exercise, diet, sexuality, vacation care, and obesity. A confluence of circumstances can interfere with provision of ostomy care.
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Peristomal Skin Complications: Prevention and Management
Peristomal skin complications are the most common reason ostomy patients visit an outpatient wound, ostomy, and continence nursing service. Prevention and management of peristomal skin complications are critical components of ostomy care. Identifying risk factors for the occurrence of peristomal skin complications according to types of injury and clinical features can help optimize assessment and management approaches. Treatment can further be addressed based on etiology - chemical injury (irritant contact dermatitis, pseudoverrucous lesions, and encrustations); mechanical injury (pressure/shear, stripping, mucocutaneous separation, mucosal transplantation); infection (Candidiasis, folliculitis); immunologic disorders (allergic contact dermatitis); and disease-related lesions (varices, pyoderma gangrenosum, malignancy). The importance of prevention and the impact of having access to knowledgeable care providers cannot be over-emphasized. KEYWORDS: skin care, ostomy, contact dermatitis, pyoderma gangrenosum, candidiasis, peristomal skin
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Strategies for Improving Ostomy Outcomes
Clinicians caring for ostomy patients, regardless of the care setting, frequently feel isolated and hampered in their attempts to respond to patient and employer needs - often the two seem completely contradictory. Ostomy surgery easily lends itself to an analysis of outcomes because surgical cases are much more likely than medical cases to follow a standard path. ...
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The Battle of the Bulge and Ostomy Care
Although not a uniquely American phenomenon, Americans seem to be paving this downhill path. What does all this have to do with ostomy care? The emergence of bariatric medicine is a testament to these facts.
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Randomized Crossover Comparison of Adhesively Coupled Colostomy Pouching Systems
Ostomy pouching systems affect well being and quality of life, making selection of the appropriate system a key element of ostomy care. Several innovative adhesively coupled, two-piece systems are on the market. They feature flexible low profiles, allowing pouch removal/replacement without changing the skin barrier or wafer. This facilitates inspection or pouch changes without disrupting peristomal skin. Because few controlled trials compare pouching system effectiveness, a prospective, randomized open-label, crossover study was conducted. Under the supervision of ostomy care nurses in six outpatient clinics in Germany, clinical performance of and patient preferences for two adhesively coupled, closed-end pouching systems were compared during normal use. One is a gelatin/pectin-based skin barrier sealed to the pouch with a company-specific adhesive coupling technology (System E); the other, a grooved base plate wafer adhesive pouch coupling system (System F). Seventeen attributes and seven end-of-study measures that included comfort, flexibility, wear time, ease of removal, and overall performance were assessed. Informed, consenting participants were randomly assigned to use one system for five skin barrier/wafer changes or up to 15 days and subsequently switched to the alternative system for a similar period. The 39 participants used a total of 1,645 pouches and 342 skin barriers. All were found safe as determined by incidence and nature of the reported peristomal skin problems, subject withdrawals, and adverse events for both systems. However, System E provided longer pouch wear times (P < 0.01). End-phase ratings favored System E on 10 of the 17 attributes (P <0.04) and System F on none. More participants preferred System E on all seven end-of-study measures, five significantly (comfort, flexibility, wear time, ease of removal, and overall performance; (P <0.02). These participant-reported, ostomy-related outcomes underscore the importance of product evaluation and selection for persons with an ostomy.
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Individualized Care
To assist staff with the complexities of ostomy care, Christa wrote a teaching booklet , "Nursing Interventions for the Ostomy Patient," to provide staff with guidelines for caring for an ostomy patient. But patient care is her first source of satisfaction. Christa emphasizes that clinicians must recognize their patients' feelings.
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Prescription for Excellence: An Ostomy Clinic
Individuals scheduled for ostomy surgery and those with a new or established stoma benefit from the services of a Certified Ostomy Care Nurse or Certified Wound Ostomy Continence Nurse provided in an ostomy clinic. The clinic can provide pre- and postoperative services as well as long-term holistic care. Developing a clinic requires an organized and well thought-out plan that identifies unmet patient needs to justify the importance of this ambulatory service to facility administrators. The plan should include configuring and preparing the area where care will be provided, advertising the services offered, and determining hours, staff, policies, and procedures with particular attention paid to facility and regulatory specifications. After establishing a clinic in a large, urban, acute care hospital, patient visits averaged 33 per month and the scheduled 6 hours per week of clinic time needed to be expanded to meet the needs of those requesting appointments. Once established, patient outcomes and provider satisfaction should be recorded. Certified Ostomy Care Nurses and Certified Wound Ostomy Continence Nurses have a responsibility to inform their patients about the ostomy clinic option when it is available and clinic clinicians should continue to share the results of their efforts to proliferate the ostomy clinic concept. KEYWORDS: ostomy clinic, stoma clinic, education, marketing, ambulatory care Ostomy/Wound Management 2005;51(9):32?38
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Creating an Ostomy Product Formulary
Next, evaluate the current processes for selecting ostomy supplies for patients, product usage patterns, and ostomy supply costs, including the cost of the labor for the care providers using them. Now, compare the ostomy supplies currently being used to those under consideration for the formulary. An ostomy formulary cannot exist as a separate entity from ostomy care...
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Challenges of Ostomy Care and Obesity
In the United States, 13 to 16 million people are morbidly obese to the extent that medical intervention, simply based on obesity-related comorbidities, is needed. The challenge of ostomy care and the very obese patient lies in the skill and planning required for successful physical, emotional, and spiritual recovery. It is commonly believed that from the onset, the obese patient having surgery is at a significant disadvantage. Care of the obese patient requiring ostomy surgery includes considerable challenges - from preoperative preparation, including finding an optimal location for stoma placement, to the challenge of preventing complications during the intraoperative and postoperative phases of care. Concerns regarding pain management, immobility, skin injury, respiratory issues, embolic threats, and caregiver injury increase when treating the obese patient and must be addressed specifically. A case study approach is used as a framework to discuss the ostomy experience. KEYWORDS: obesity, bariatric, ostomy, colostomy, surgery
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