The importance of holistic approach to stoma care. A case study.

Ms Melanie Perez1, Ms Anne Mamo RN, BN, DipAppSc (Nursing), MN (ClinLead)2, Daniela Levido RN2
1St. George Public Hospital, Hebersham, Australia; 2St George Public Hospital, Kogarah, NSW.

This case study looks at the importance of providing a holistic approach to stoma care. The goal is to show the different challenges that arises in pouching a high output ileostomy, enterocutaneous fistula, and ileal conduit with foley catheter in situ. It also explores the impact of the different challenges on the patient physically, emotionally and socially. Additionally, it delves on the difficulty of discharging a patient with a complicated case, requiring different needs and resources. Finally, this case highlights the therapeutic and comprehensive care that the stomal therapy nurses provides the patient and their family.


Biography:

Anne has over 20 years’ experience as a Stomal Therapist, currently working as a Clinical Nurse Consultant at St George Public Hospital.  This is a major tertiary referral hospital and also includes both trauma and Peritonectomy Services.  This results in a very complex client mix with many clinically challenging wound and Stoma issues. She has a great passion in advanced clinical problem solving and developing wholistic and individualised plans of care.

Daniela has over 10 years of Stomal Therapy experience and is currently working as a Stomal Therapy Clinical Nurse Consultant at St George Public Hospital. As a major teaching hospital and tertiary referral centre covering many specialities including Colorectal, Peritonectomy and Trauma the acuity and complexity of patients can present many challenges. Daniela is passionate about her role and the work they do at St George Hospital and has a special interest in patient centred outcomes and multidisciplinary discharge planning.

Enteroatmospheric Fistula – Caring for Mind and Body

Mrs Renee Matthews1, Mrs  Kristie Willis1
1Launceston General Hospital, Launceston, Australia

Enteroatmospheric Fistula – the mere term ignites terror in any Stomal Therapists’ minds. HOW AM I GOING TO MANAGE THIS?!??!

This presentation follows Annie’s journey and examines the transformation from an enteroatmospheric to enterocutaneous fistula and will focus on the problem-solving techniques used to facilitate healing. We will explore the management techniques used throughout including effluent containment, wound irrigation and suction, fistula isolation, fistula adapter, negative pressure wound therapy, skin grafting and the ultimate aim – REVERSAL.

The wound transformation was nothing short of incredible, but wouldn’t have been possible without the amazing and inspiring determination and positive outlook that Annie showed throughout her year of hospitalisation. In addition to a multidisciplinary approach used for this wound, it was also essential to consult with colorectal surgeons, wound care consultants and our Stomal Therapy colleagues.

Wound healing was finally achieved, facilitated by holistic care with a cohesive approach by all members of the health care team. In Stomal therapy we are constantly challenged therefore problem solving is paramount. No two problems are the same, there is no ‘quick fix’ no ‘standard’ intervention.


Biography:

Renee graduated from University of Tasmania in 2006 with a Bachelor of Nursing. After completing a postgraduate year in Tasmania, she then went on to work throughout England and Scotland. Returning home in 2010, she completed her Professional Honours and Masters in Clinical Nursing. Whilst working on a Colorectal/Urology Surgical ward she obtained her Stomal Therapy Certificate in 2015. Renee has a keen interest for Stomal Therapy Nursing and is always enthusiastic to further develop her skills in this speciality. She currently works as an Associate Nurse Unit Manager and relief Stomal Therapist within the Launceston General Hospital.

Kristie has been a Registered Nurse for 15 years and 9 years as a Stomal Therapy Nurse.  During that time, she has worked intermittently as an Stomal Therapy Nurse at the Launceston General Hospital.  Kristie has two sons and also works part-time as an Associate Nurse Unit Manager on Ward 5A a busy colorectal and urology surgical ward at the Launceston General Hospital. Kristie has a passion for Stomal therapy and enjoys educating ward staff in this area. Kristie also finds seeing the patients journey from preoperative counselling through to discharge extremely rewarding.

“Tummy troubles”

Mrs Sonia Hicks1
1Royal Hobart Hospital, Hobart, Australia

This paper will endeavour to give you an overview of the management of a Small Bowel Fistula that occurred during Gynaecological surgery February 2018.  A 41 year old female was to undergo an Elective Hysterectomy, unfortunately we hit Tummy Troubles!  This  patient was transferred from a Private Hospital to Royal Hobart Hospital for management of a small bowel fistula and Open Laparotomy wound.

The V.A.C Ulta  was used to manage healing until a pouching system could be applied. After spending 6 months in hospital our patient was discharged to attend the Stomal Therapy Department for fistula pouch changes three times a week!!!

Surgery is planned for December 2018 to close small bowel fistula.


Biography:

Sonia has over 25 years of experience in Stomal Therapy as a Clinical Nurse Consultant at the Royal Hobart Hospital.  Sonia provides services to all hospital inpatients of the RHH and the Hobart Private Hospital as well as seeing patients in the community.

Royal Hobart Hospital is the major tertiary and referral hospital in Tasmania covering many specialities resulting in very complex and challenging patients.

Sonia is very well versed and passionate Stomal Therapy Nurse.

Clinical management of high output ileostomates to prevent dehydration and acute kidney injury: A quality improvement activity

Ms Jodie Gordon
1MNHHS – Redcliffe hospital, Redcliffe, Australia, 2MNHHS , Herston, Australia

Ileostomates are at risk of developing high output stoma (>1000mls per day) and may be readmitted to hospital with dehydration and acute kidney injury (AKI) (Hayden 2013, Mackowski et al 2015, Slater 2012 & Villafranca et al 2015).  These poor outcomes were identified at our hospital as an area for improvement and an interdisciplinary working party was convened to improve patient outcome with a secondary aim to reduce readmission rates directly attributed to dehydration or AKI for our ileostomate cohort.  This team included STN, Director of Surgery, Colorectal Surgeons, Nursing and Dietetics.

We identified that there is no consistent clinical management for high output stoma within our facility; with multiple accepting teams across critical care, medicine and surgery in terms of readmission.

This inconsistent approach led to treatment plans that were not in keeping with current evidence based practice of high output stoma.

Our motivation was to develop a clinical management tool that was easy to use, evidenced based and enabled early intervention for high output stoma management.  This in turn will aid in the reduction of readmissions for dehydration and AKI for high output ileostomate as our quality improvement outcome.


Biography:

Jodie has Master Degrees in Wound Management and in Health Administration and a Grad Cert Stomal Therapy Nursing.  Her commitment to lifelong learning, value based healthcare, and providing the right care to the right patient at the right time continues to be a driver in improving patient care.

The development of a clinical practice guideline for high output stoma management for adult patients at a regional hospital in Western Australia

Felicity Jones1
1WA Country Health Service – South West, , Australia

A high output stoma (HOS) is a common complication experienced by patients with a small bowel faecal stoma, enterocutaneous fistula or the result of intestinal failure or short bowel syndrome. A HOS has been defined as fluid losses between 1000-2000ml over 24- 48hours which results in water, sodium and magnesium depletion. If the high output is not managed appropriately it can lead to dehydration, electrolyte imbalances, malnutrition, acute renal failure, poor quality of life, readmissions to hospital and increased length of hospital stay. There are various management strategies for a HOS which aim to reduce and prevent further complications, but they do require coordination within the multidisciplinary team to be effective. The aim of the project was to develop a clinical practice guideline for HOS management for adult patients in a regional hospital in Western Australia. The development of a clinical practice guideline is to assist health care practitioners in the provision of a standardised and structured approach to care for these patients, and to facilitate optimal care outcomes for patients with a HOS. The clinical practice guideline was developed using current evidence found in the literature and in consultation with the multidisciplinary team of health care professionals and an external peer review group. The evidence based clinical practice guideline developed will be presented to the hospital for consideration for implementation.


Biography:

Felicity Jones is a Clinical Nurse Specialist in Stomal Therapy and Wound Management at Bunbury Regional Hospital in Western Australia. Felicity works in the acute care setting and provides nurse led outpatient clinics. She also has a regional role providing clinical support and education to 12 sites in the south west region. Felicity is committed to rural health care and has recently completed her Master of Nursing Nurse Practitioner with a view to improving access to specialty services outside the metropolitan area.

AASTN

This conference is proudly hosted by the Australian Association of Stomal Therapy Nurses: www.stomaltherapy.com

One of the Association's major objectives is the promotion of quality care for a wide range of people with specific needs. These needs may be related to ostomy construction, urinary or faecal incontinence, wounds with or without tube insertion and breast surgery.

Patients/clients across the life span are provided with preventative, acute, rehabilitative and continuing care as required. Another objective is the maintenance and improvement of professional standards in relation to Stomal Therapy Nursing Practice to the highest degree possible. Recognition of the need for and encouragement of the development of specialist expertise in the field of Stomal Therapy Nursing underpins the Standards for Stomal Therapy Nursing Practice.

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