Authors: (including presenting author): :
Ngan HL, Lam WSJ
Affiliation: :
Nursing Services Division, United Christian Hospital
Introduction: :
Improper pouch placement over stomas would cause pouch leakage and that leading to wound contamination or peristomal skin irritation. Both wound & stoma care team and frontline staff in surgical unit are well-trained in providing the stoma care once after the stomal construction. However, there was a couple of reporting from Intensive Care Unit (ICU) or Department of Surgery, wound contaminated with effluence from stoma due to the pouch leakage immediate after patient transferred to ward post-operatively. After conducting the root-cause analysis proactively, pouching system would be firstly applied in the Operating Theatre (OT) by surgeon or nurse immediately after the wound closed and they would try to secure the dressing on main wound before applying the pouch with well adherence. To promote the proper pouch applying technique so as to facilitate post-op wound and stoma care, we have been cooperated with different departments including surgeons from department of Surgery and OT.
Objectives: :
Applying the principles of stoma care and promulgating the effective protocol of stoma care in OT setting to reduce the risk of pouch leakage post-operatively.
Methodology: :
In April- August 2018, Wound & Stoma Care Team had collected the data of the incidence of stoma pouch leakage on postoperative day in ICU and surgical department accompany with the clinical photos to look for the reasons of every incidence. At the same time, we had discussed with the surgeons and OT nurses on the application method of the stoma pouch and recognized their rationale behind the discrepancy from ward practice. At last, we had come up with a consensus on stoma care. In order to ensure all the involved parties, including surgeons and OT nurses, are in line with the practice of stoma care, an enhancement project through in-service training and promulgation were then implemented.
Result & Outcome: :
In October 2018, two identical in-services training workshops with the newly developed quick reference of stoma care were provided to OT nurses. Moreover, promulgation to surgeons was held in surgical department meeting to increase their awareness on working out with the protocol. As a result, the incidence of pouch leakage on post-operative day was significantly reduced after the implementation of the enhancement project since there is no more reporting of the problem. Wound & Stoma Care Team will keep monitoring the outcomes of the project and the incidence of stomal pouch leakage to ensure the quality of care on patient with stomas.
Co-location with:
