Can rectal irrigation improve quality-of-life for patients who have bowel dysfunction?

Mrs Lisa  Richards1, Mrs Cheryl Penter1
1St John Of God Hosptial, Subiaco, Ardross, Australia

Colorectal surgeons are more skilled now than ever. This has led to surgical resections as low as ultra low anterior resections with hand sewn coloanal anastomoses and temporary loop ileostomy to rest the anastomosis.

Following stoma reversal many of these patients suffer bowel dysfunction known as low anterior resection syndrome (LARS). This results in clustering, frequency and urgency of bowel actions and can be debilitating for many.

At St. John of God hospital Subiaco we have been teaching our patients how to perform rectal irritation in an attempt to give these patient more predictable bowel functionality.

Anecdotally these patients have been reporting a much improved bowel function and improved quality of life.

This inspired us to commission a research project with the aim being to determine if rectal irrigation can improve this cohort of patients quality of life.

The research was extended to not only include LARS sufferers but any patients with bowel dysfunction and is being measured using the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire.


Biography:

Lisa Richards has worked as a registered nurse at St John of God Subiaco since 1987. She has been a Clinical Nurse Consultant in Stomal Therapy for the past 10 years.

Lisa is the current Vice President of the WA Branch of the AASTN and has been an active committee member for the past 8 years.

Cheryl Penter is the Clinical Nurse Consultant/Research Nurse at St John of God Hospital, Subiaco working as a member of the Subiaco Colorectal Unit a position she has held for 12 years.

This role encompasses a specialist nurse position with a strong focus in management of all cancer patients through the unit, collating data for both neoplasia and benign databases, coordinating the collection of biological specimens within the CRC unit and hospital based research projects.

Lisa and Cheryl work closely as part of a cohesive multidisciplinary team at St John of God, Subiaco and are both committed to the advancement of nursing excellence in order to achieve optimal patient outcomes.

Granulomas what they are, how they affect ostomates and methods of treating them successfully

Mrs Cheryl Jannaway1
1Act Health, Monash, Australia

Granulomas  are small areas  of granulation tissue, that can be painful, bleed easily and cause problems with stoma appliances sticking leading to leakages.

My presentation is looking at the different methods I used to  treat granulomas and the results I obtained. I have seen a number of ostomates in stoma clinics in the ACT with granulomas and found difficulty finding information on how to treat them successfully.

The purpose of my presentation is to describe what granulomas look like, how they develop, what are the causes and the affect they have on an ostomate. I began by researching the different methods used by stoma nurses in Australia,  the UK and the USA by studying their clinical guidelines and research papers.

The goal of my presentation is to explain the treatments I used to treat granulomas and present case studies on  2 patients I treated and the results of the methods I used.

It is hoped that the experience I have gained from treating granulomas, explaining the methods I used and the outcomes, that clinicians will be able to use this information in their own practice.


Biography:

My name is Cheryl Jannaway and have worked in the position of Clinical Nurse Consultant Stomal Therapy Nurse for 3 years. I have worked as a Community Nurse for ACT Health for the last 9 years.  I completed the stomal therapy course in 2010 at the College of Nursing in Sydney and became a Registered Nurse 21 years ago in the UK. I travelled to Australia 14 years ago with my husband and 3 children and now have 3 grandchildren. I have been elected as the President of the ACT AASTN for the last 5 years.

Preoperative stoma marking in the general surgery population.

Dr Linda Vu1, Mrs Deborah Sinclair1, Mrs Laura Hughes1, Dr. Mary Theophilus1
1St. John Of God, Subiaco, Australia

Purpose: Preoperative stoma site marking is supported by research and professional organisations as an intervention that can reduce the incidence of stoma complications. This study investigates the application of this research into practice in an Australian metropolitan hospital. The aim was to achieve 100% preoperative stoma marking for elective patients and determine the rate of preoperative stoma marking in the emergency population.

Methods: A retrospective review of prospective collected data was conducted. Data from January 2018 to October 2018 was reviewed. The end point was the rate of preoperative stoma marking. Descriptive analysis examined the percentage of patients marked preoperatively in the elective and emergency setting, stoma complications, the relationship between preoperative length of stay (LOS) and sited emergency patients.

Results: A total of 67 patients underwent a surgical procedure that resulted in a faecal ostomy over a 10 month period. In total 59.7% (40/67) were emergency patients and 40.3% (27/67) elective. The median age was 64 (Range 26-91), 53.7% (36/67) females and mean BMI of 27.1 (SD = 7.16). In all, 52.2% (35/67) of the stomas were sited. Of the elective patients, 77.8% (21/27) were sited compared to 35% (14/40) emergency patients. Of the emergency population, median LOS preoperatively for non-marked patients was 0 (Range 0-6) compared to 2 (Range 0-10) for marked patients.

Conclusions: At this metropolitan hospital three quarters of the elective population are marked preoperatively and only one third are marked in the emergency setting. This rate is partly contributed to by only having 2 stoma trained nurses and lack of communication about surgery dates.

Reference: Hendren S, Hammond K, Glasgow S,Perry B. Clinical Practice Guidelines for Ostomy Surgery. Diseases of the Colon and Rectum. 2015; 58:375-387.


Biography:

Dr. Linda Vu is an unaccredited surgical registrar from WA. She graduated from the University of Notre Dame in 2014. She completed a Masters of Science in 2018 looking at risk factors in anastomotic leaks. She has worked in different general surgery and colorectal units for the last 3 years. She has a keen interest in colorectal surgery, patient outcomes and holistic multidisciplinary care.

Overcoming problems with stoma site placement and improving quality of life after urinary diversion

Mrs Patricia Walls RN. STN.1
1St Vincent’s Northside Brisbane, Queensland, Australia, ,

Stoma placement requires careful assessment preoperatively. However, post-operatively, changes in body contours can occur that cause problems with stoma  management. Complications after any major surgery can be distressing for a patient and inhibit recovery and rehabilitation particularly if leakage occurs. In 2014 in Australia, there were 2,748 new cases of bladder cancer diagnosed1. In 2015, radial cystectomy was associated with high morbidity (50%) and mortality (8%). In Australia, length of hospital stays (LOS) for radical cystectomy ranges between 10 to 20 days with an average LOS of 14 days. Prolonged length of stay (>14 days) is not uncommon2. Approximately 75 to 80% of patients experience one or more complications despite improvements in surgical techniques, ostomy appliances and ostomy care3,4. The predominant complications are peri-stomal skin related. The challenge for the stomal therapy nurse is to provide a patient-centered care approach as well as the implementation of practical stomal therapy ‘tricks of the trade’ when ostomy problems arise to ensure the best possible outcomes for patients. The case study will outline the care of an elderly patient who underwent a radical cystectomy and creation of an ileal conduit. ‘Tricks of the trade’ used to overcome problems associated with constant leakage and his subsequent loss of self-esteem will be discussed.


Biography: 

Patricia Walls is a Clinical Nurse Consultant, Stomaltherapy and Wound Management,  St Vincent’s Northside , Brisbane .

Pat completed the Stomal therapy course at the Princess Alexandra Hospital in Brisbane in 1982 and a Graduate Certificate in Wound Management at the University of Central Queensland in 1999. Her Stomaltherapy experience has covered community, paediatric and in the acute care setting.

Pat is actively involved with Stomal therapy nursing, participating at National and International  conferences.

The man behind the woman: Rupert B Turnbull Jr – father of Stomal Therapy

Mrs Naomi  Houston1
1Nepean Blue Mountains Local Health District, Kingswood, Australia

Formation of an abdominal stoma is a relatively straightforward procedure in contemporary medical practice. Minimal complications result and patients are able to return to a comparatively normal life.  Yesterday was different. Between days of Hippocrates (400 BCE) right up until the middle of the 20th century, intestinal surgery, especially of the small bowel, resulted in poor survival outcomes.

Between 1950 and 1970, key milestones were made surgically and also in the area of stomal therapy. Norma Gill, the lady known as the ‘mother of stomal therapy’ plays a key part and so does her surgeon, Rupert Turnbull Jr. However, little is known about Rupert Turnbull.  Who is this man and why is he so significant? This presentation briefly explores Rupert Turnbull’s life and why he is so significant to the stomal profession.


Biography:

Naomi Houston is a stomal therapy nurse for Nepean Blue Mountains Local Health District and is based at Nepean Hospital.

Before coming to Nepean she worked as a Health and Community Care Instructor at Mission Employment for 10 years training long term unemployed basics in nursing skills. Such a role equipped students to work either as an Assistant in Nursing or pursue further education.

She completed her nursing training at Royal Prince Alfred Hospital. She has a post Graduate degree in Family Health and a Masters in Primary Health Care – University of Western Sydney.

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.

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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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