Ostomy Patient Care Standards

The following ostomy patient care standards have been developed for use in the IBD unit at Mount Sinai Hospital. It is the combined effort of the multidisciplinary team that provides the holistic care for patients families coping with Inflammatory Bowel Disease.

Educational strategies and sessions need to be geared towards meeting the outcome standards.

Outcome Standards

• Patient demonstrates manageable level of anxiety as evidenced by verbal and non-verbal Patient demonstrates positive self-concept as evidenced by verbal and nonverbal indicators of self-esteem (ability to cope, plans to resume lifestyle and relationships, continued self-care activities, grooming).

• Patient/family demonstrate adaptive grieving as indicated by ability to share feelings, ability to share emotions in a healthy manner, ability to participate in activities of daily living and decision-making.

• Patient/family verbalize understanding of disease process, planned medical/surgical procedure/treatment, alterations in physical appearance and options for management as a result of medical/surgical intervention.

• Patient/family describe anticipated effects of medical/surgical intervention on lifestyle including occupational, school, social and sexual aspects.

• Patient has optimal stoma site placement to promote self-care and rehabilitation.

Post-operatively and Ongoing

• Patient attains/maintains adequate nutritional status as indicated by laboratory values reflecting protein stores and other clinical indicators of nutritional status (weight, general appearance, presence/absence of edema, decreased muscle mass, appetite, nutrient intake). More applicable to an ileostomy

• Patient maintains adequate fluid and electrolyte balance as evidenced by fluid intake, urinary output, vital signs, electrolytes, hemoglobin, haematocrit, and absence of signs and symptoms of fluid/electrolyte imbalances. More applicable to an ileostomy.

• Patient and/or family describe daily Ileostomy/Colostomy care and options for management.

• Patient and/or family demonstrate how to properly empty and change the ostomy pouching system.

• Patient attains/maintains intact peristomal skin and incisional tissue integrity.

• Patient and/or family demonstrate understanding of appropriate peristomal skin care for prevention/management of breakdown.

• Patient and/or family demonstrate an understanding of potential complications following Ileostomy/Colostomy surgery and measures to take if complications should occur. Potential complications include mechanical/food-related blockages, high Ileostomy outputs.

• Patient verbalizes ability to resume, maintain or initiate a satisfactory sexual relationship.

• Patient/family will resume role-related responsibilities and relationships to extent patient and family have set goals for.

• Patient and/or family will resume role-related responsibilities and relationships to extent patient and family set goals for.

• Patient and/or family identify/assess the resources needed for effective management of Ileostomy/Colostomy in home setting.

Process Standards

Members of the multidisciplinary team become involved with the patient/family either through direct referral from the primary nurse, physician, or other team member; discussion at "bullet rounds"; patient care conferences; pre-admission questionnaire that would identify "at risk" patients or at the pre-admission visit.

• In collaboration with the team, the nurse assesses the patient/family's level of anxiety and plans interventions aimed at reducing anxiety, as appropriate.

• In collaboration with the team, the nurse assesses the patient/family's perception of the surgery/medical intervention in relation to effect on self-concept and plans interventions aimed at attaining/maintaining a positive self-concept.

• In collaboration with the team, the nurse assesses the patient/family's grieving response and plans interventions to facilitate the normal grieving process.

• In collaboration with the team, the nurses assesses the patient/family's understanding of the diagnosis, prognosis, planned medical/surgical intervention and initiates /reinforces patient/family education based on readiness and ability to learn.

• In collaboration with the team, the nurse assesses the potential effect of surgery (Ileostomy/Colostomy) on the patient’s lifestyle and initiates/reinforces patient/family education as well as interventions aimed at providing support.

• In collaboration with the team, the nurse ensures that stoma siting according to pre-established criteria is completed pre-operatively.

• In collaboration with the team, the nurse assesses the patient’s nutritional status and plans interventions aimed at maintaining/restoring nutritional status.

• In collaboration with the team, the nurse assesses the patient’s fluid and electrolyte balance and plans interventions aimed at maintaining/restoring balance.