Maki Jerden, DNP, MSN, RN, GNP-BC, CWON, RNFA

Abstract:

Background: An estimated 750,000 to 1 million people live with an ostomy, and approximately 100,000 – 120,000 people undergo the creation of a new ostomy surgery every year. Faster recovery times have decreased ostomy patients’ post-operative hospital length of stay (LOS). As a result, patients have limited time to receive adequate ostomy education and training during hospitalization. Because the LOS is short, providing necessary patient education, training, and stoma site marking (SSM) before ostomy surgery as an outpatient can impact patients’ well-being, decreasing ostomy-related complications and reducing financial burden. Objectives: This preoperative ostomy care quality improvement (QI) pilot project aimed to evaluate the impact of providing preoperative ostomy education, care training, and stoma site marking (SSM) on patients undergoing scheduled fecal ostomy creation surgery, including length of stay (LOS), emergency department (ED) visitation, and readmission occurrences associated with ostomy issues including dehydration and acute renal insufficiency. Methods: This QI project was a single-site project at a large community hospital in Los Angeles County. The project's subjects included two groups of adult patients who had undergone scheduled colorectal surgery for new fecal ostomy creation: those who had surgery prior to initiation of the QI project (non-intervention group); and those who had surgery after initiation of the intervention for the QI project (intervention group). The QI project used a pre-and post-intervention design and was guided by the Plan-Do-Study-Act (PDSA) cycle. The intervention implementation was for four months, and the data collection was for a total of five months. Due to the small sample size, a descriptive statistical analysis was used. Results: The control group had 26 participants, and the intervention group had five participants. The average LOS in the control group was 7.2 days, and 3.8 days in the intervention group. The total 30-day post-discharge ED visits were six cases in the control group (23.1%) and none in the intervention group (0%). The total 30-day post-discharge readmission was five cases in the control group (19.2%) and none in the intervention group (0%). Conclusion: Despite the small sample size, a more than three-day reduction of average LOS, and a reduction to zero readmissions or ED visitations are clinically and financially meaningful findings. Further research with larger sample sizes to examine generalizability is recommended. 

Click here to see the full manuscript.