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Ostomy Management in Hospital Setting

Arum Pratiwi, ETN

Siloam Hospitals Surabaya

History

• Stoma has been writen about for over 2000years.

• In 1700s there were severa successful surgicaly exteriorised bowels.

• The eary recorded success in stoma care was a battle wound. George Deppe was injured in 1706 and he lived for 14 years with a prolapsed colostomy (Cromar 1968)

Background

• Patient who receive pre operative ostomy educationexperience better recovery, shorter hospital stay andfewer compiclations (Golldberg et al, 2010)

• Stoma sitting as a part of ostomy management may decrease ostomy related complication such as leakage or peristomal dermatitis

• Helping pouches stay longer• More indipendent patient• Control healthcare cost• Bill of rights

Bill of rights

• Be given pre-op counseling• Have an appropriately

positioned stoma site• Have a well-constructed

stoma• Have skilled pre-operative

nursing care• Have emotional support• Have individual instruction

• Be informed on the avaiability of supplies

• Be informed on community resources

• Have post hospitals follow up

• Benefit from team effortsand helath care professionals

• Be provided with information and counsel from ostomy association/ member

OSTOMY MANAGEMENT

Education

Stoma

Siting

Post op

Care

EDUCATION

Brief discussion about anatomy and physiology of afected area

Procedure

Lifestyle adjustment

Introduction to ostomyequipment

The challanges are:

• The role of stoma nurse isn’t recognised• The explanation from surgeon only is enough• No plan for ostomy surgery• Emergency case

STOMA SITING

“Stoma siting is underrated”

Why ?

• I (Surgeon) can do thisby myself. We’ve donethis for years

• Emergency surgery

• No trainned staff

What is Stoma siting

“Marking the site of a

stoma preoperativey

allows the abdoment to

be assessed in a lying,

siting and standing

position”

Points to be considered

Position isssues• On wheelchairs, walker, bed confined

Physical consideration

• Big breast/ abdomen, abdominal fold, scars, waist line, iliac crest, rectus muscle, other stomas etc

Patient consideration• Age, occupation, diagnosis

Others• Type of ostomy or diversion

What we can do?

• Close discussion:Round table discuss with them

• Open discussion-Internal Case presentation-Ostomate gathering (invite the surgeon)-Oral/ poster presentation in their congress/ conference/ scientific meeting.

• Train the nurses

POST OPERATIVE CARE

Assessment

Treatment

Education

POST OP EDUCATION

Pouching Principle• How/ when to empty/ change, assess stoma/

peristoma skin, when to seek help

Dietary Concern• Ileal conduit, ileostomy,medication

Living with Stoma• Where to obtain supplies• Bathing/ clothing/ actifity

“Post operative education is morechallenging in recent years”

Length of stay limitation

Pre operative educationIs a Must

Education (pre op) Stoma Siting Post op care

The role of stoma nurse isn’t recognized

Surgeon can do that. They have been there for years.

Length of stay limitation

Explanation from surgeon is enough

Emergency case

No plan for ostomysurgery

No Trained staff

Emergency case

Speak up

Train more nurses

Early Education

• During 2015 - 2016, there were 18 patients with newstoma. Eight of them underwent elective surgery inSiloam Hospitals Surabaya. Supported by two digestivesurgeons in the hospital, 75% of patients underwent toelective surgery, had a pre operative counseling andstoma siting from ET nurses. Counceling was given inout patient department and in patient department.Three of them need an ostomate attendance to give apshicological support. Stoma siting was done a daybefore surgery.

• Five of six patients who experient an ostomymanagement before surgery, including counceling andstoma siting, is more willing to get involved in theirown ostomy care. And all of them use simple ostomypouch (one piece drainable pouch) that was resulting ina cheaper cost (40-70 ribu/ piece), need 5-7 bags/month

Key messages

• It takes 40 – 2 hours to create a stoma.

• It takes 7 – 14 days to stayin the hospitals for recovery

• But It takes forever for patient to take care of their ostomy.

ReferencesBlackley. (2004). Practical Stoma Wound and Continence Management.

Victoria. Research Publications Pty. LtdBreckman. (2005). Stoma Care and Rehabilitation. Philadelphia.

ElsevierBrewer. (2002). Diet and Nutrition Guide. United Ostomy Association,

Inc.ConvaTec USA. (2011). Common Questions about Your Child Stoma.

www.convatec.comHampton. (1992). Ostomies and Continent Diversions: Nursing

Management. Missouri. Mosby Year Book, Inc.Holister. (2010). Caring for your Child with Ostomy. www.holister.com Milne et.al. (2003). Wound, Ostomy, and Continence Nursing Secrets.

Philadelphia. Hanley & Belfus, Inc.