Genele Grace Novilla Romero, DNP, MSN, FNP-BC

Abstract:

Background: There are approximately 100,000 persons who undergo ostomy surgery each year due to colorectal cancer, inflammatory bowel disease, diverticulitis, or trauma. Absent or inadequate preoperative ostomy education leads to poor development of self-care skills resulting in increased hospital length of stay, emergency department (ED) visits, additional outpatient clinic visits, peristomal skin complications (PSCs), and ostomy pouch leaks, Objective: To compare usual preoperative care of verbal descriptions of ostomy surgery and care instructions to use of an early preoperative ostomy education (EPOE) session using brochures, visual aids, hands-on simulation, and online resources on reduction of PSCs, ostomy pouch leaks, hospital length of stay, number of ED visits, and clinic visits. Methods: A comparative, cross-sectional, quasi-experimental study compared PSCs, ostomy pouch leaks, hospital length of stay, number of ED visits, and clinic visits for 20 previously-treated (usual care) and 5 prospectively treated (intervention) adult ostomy surgery patients. All participants were treated in an outpatient colorectal surgery clinic and identified using electronic medical records (EMRs). Sociodemographic, healthcare and disease state data were collected for each subject (e.g. hospital length of stay, ED visit and clinic visit frequency, number of PSCs and ostomy-pouch leaks). Patients in the intervention group received a 30-minute EPOE session using brochures, visual aids, information resource sheets and hands on simulation of ostomy pouch application with positive feedback. The EPOE sessions were held during the preoperative clinic visit two weeks prior to surgery. Intervention patients were followed until the 10 to 14 day postoperative clinic visit. The validated Ostomy Skin Tool was used to determine PSC severity. For the control group (usual care) PSC severity was determined using the narrative description documented in the medical record while direct observation was used for patients in the intervention group. These patients also described their quality of life and self-efficacy using the City of Hope Quality of Life (CoH-QoL) Ostomy Questionnaire and the Stoma Self-Efficacy tool (stoma care self-efficacy subscale). These validated tools were administered during the 10 to14 day postoperative clinic visit. Results: Hospital length of stay, number of ED visits /clinic visits, frequency of PSCs and ostomy pouch leaks were obtained from 25 patients; 20 usual care patients and 5 intervention patients. Fifty-two percent (n=13) of the total sample of patients were female (usual care n=10; intervention n=3) and forty-eight percent (n=12) of the total sample were male (usual care n=10; intervention n=2), with a mean age of 56.7 (Standard Deviation (SD) =12.7) years. The sample was ethnically and racially diverse with the majority of patients persons of color (12% (n=3) Asian, 12% (n=3) Black, 48% (n=12) Hispanic, 8% (n=2) Native American and 20% (n=5) White). Ileostomy (56%, n=14) was more commonly performed than colostomy (44%, n=11). Intervention patients had reduced hospital length of stay (6.8, SD 2.6 days versus 7.75, SD 2.36 days), fewer clinic visits (1.2, SD 0.4 versus 1.35, SD 0.5) and fewer unscheduled clinic visits (0.2, SD 0.45 versus 0.35, SD 0.49) compared to usual care patients. At the postoperative clinic visit intervention patients presented with fewer ostomy complications compared to usual care patients (60%, n=3 versus 35%, n=7). Measurements using the Ostomy Skin Tool, intervention patients had less severe peristomal skin damage as compared to controls (1.2, SD 0.5 versus 1.4, SD 0.4). Intervention patients had a CoH-QoL Ostomy Questionnaire average score of 7.6 (SD 1.9) with domain scores from 7.0 (SD 1.9) for psychological QoL to 8.0 (SD 1.9) for spiritual QoL with higher scores indicating better QoL. The Stoma Self-Efficacy tool stoma care subscale scores for intervention patients were 56.8 (SD 9.7). These scores indicate higher confidence and self-efficacy among patients who received EPOE. Conclusion: Introducing an EPOE session compared to verbal preoperative instructions (usual care) may reduce hospital length of stay, clinic visits, PSCs, and ostomy pouch leaks. Although, these findings are not statistically significant due to small patient numbers, outcomes from hospital length of stay, additional outpatient clinic visits, and PSCs showed a decrease in scores compared to the usual care group which may help decrease the economic burden of additional costs related to ostomy complications.

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