Improving Self-Care Outcomes in Ostomy Patients via Education and Standardized Discharge Criteria.

ABSTRACT

Adjusting to life with a new ostomy is a daunting prospect for many patients. Without proper education, complications can occur, some requiring hospital readmission. Many home healthcare nurses also face the challenge of training new ostomy patients in self-care. The purpose of this quality improvement pilot study was to improve outcomes in a sample of new ostomy patients by implementing an intervention consisting of nurse and patient education. The study was conducted at a Southern California home healthcare agency with an average patient census of 270. The participants were 30 home healthcare nurses (6 licensed vocational nurses and 24 registered nurses). We followed the outcomes of four home healthcare patients with new ostomies. The nurse ostomy education session included both didactic and hands-on components to promote practice change. Patient education was guided by the use of an evidence-based ostomy skills checklist adapted from the Wound, Ostomy, and Continence Nurses Society's ostomy discharge criteria. Nurse's skills and competence were measured and compared via results from a 10-question pre- and postintervention nurse self-assessment survey. Patient outcomes were measured and compared via pre- and postintervention chart reviews examining three factors number of weeks on service, number of visits to reach independence, and number of unscheduled visits. Statistical analysis of survey data showed a significant change in the scores for all questions, indicating the nurses felt more confident managing ostomies after the education session. After the intervention, the number of weeks patients were on service for a new ostomy diagnosis decreased by an average of 1.5 weeks; patients required 50% fewer visits to reach independence; and unscheduled visits decreased by 500%.