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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.