ReferencesAssociation of Stoma Care Nursing Standards UK (2015). Nursing Standards and Audit Tool. https:tinyurl.com/nrohu49 (accessed 21 February 2017). Elcoat, C (2015) in Association of Stoma Care Nursing Standards UK (2015) Nursing Standards and Audit Tool. https:tinyurl.com/nrohu49 (accessed 21 February 2017). Royal College of Nursing (2009) Clinical Nurse Specialists Stoma Care. Royal College of Nursing, London.

Authors: Metcalf C, Benn A, Dhamala-Bhatta S, Shamsi A, Whale P, Cowie J, Allison L, Evans S, Perry-Woodford Z

Introduction: Nurse specialists in stoma care are in a strong position to identify and initiate research. However, many feel daunted by the prospect despite it being an essential descriptor for the role (Royal College of Nursing, 2009). To build confidence in this area, an audit of service provision can be a good starting point. In addition results can be included in an annual report, used as part of the nurses’ annual appraisal and contribute to revalidation.

ConclusionIn response to the question ‘how good is the stoma service we provide?’ the results demonstrate that we are providing a good quality service in many areas of which the team should feel justifiably proud. However, it has also highlighted several areas where care is not at the standard we expect and from this the team have been able to discuss, plan and agree ways in which this can be addressed over the next year.

Distribution of findings and re audit

Results were disseminated to relevant stakeholders and a summary included in the stoma care annual report. In order to complete the audit cycle the audit will be repeated in 2018.

An audit proposal was written and discussed with the lead nurse for the service. This was presented to the other nurses in the department highlighting where their contribution was required with identifying suitable patients and collecting the necessary information. Nurses were asked to print off an extra copy of the patient discharge letter and file in the stoma service audit file by month of discharge having first checked that the patients telephone number was correct and that they had been given or sent a letter explaining the purpose of the audit.

Information regarding the inclusion and exclusion criteria used were displayed in the front of the file to remind the nurses which patients needed to be included in the audit. The audit was registered with the Trust’s clinical audit department.

A minimum of 30% of the annual numbers of new ostomates having a stoma formed was required for the audit to be representative (ASCN, 2015).

The hospital was projected to receive 282 new patients, so 86 (30%) interviews were conducted.

Demographic information

This information helped establish that the opinions of patients were representative of the population.

Total number of patients = 86

Sex: male n=57 (66%); female n=29 (34%)

Age: 17-85 years (mean 51 years)

Lcoation: local n=22 (25%); tertiary n=64 (75%)

Stoma type: ileostomy n-66 (77%); colostomy n=18 (21%); jejunostomy n=1 (1%), urostomy n=1 (1%)

Temporary vs permanent: temp n=55 (64%); perm n=31 (36%)

Data Collection

Patients were contacted one month after discharge. Telephone interviews were conducted by the departmental administrator (to reduce bias) using the ASCN patient satisfaction questionnaire.

Data was collated on to an Excel spreadsheet and the findings analysed.

• An action plan was devised based on patient responses not meeting the ASCN standards more than 80% of the time.

• The plan was discussed and agreed at a team meeting.

• Individual nurses were responsible for ensuring that the various actions were completed and the date achieved documented.

• All actions were completed within 3 months (apart from the patient’s information book being published).

Aim: An audit was undertaken using the Association of Stoma Care Nursing Standards (ASCN 2015) to allow the stoma care team to benchmark their current service.

Standard Quality StatementReferral for potential/actual planned stoma formation

Patient/carer will be referred to a specialist stoma care nursing service in a timely manner to ensure adequate time for pre-operative information to be delivered.

Pre-operative preparation for potential/actual planned stoma formation

Patient/carer consented for potential/definite stoma formation will be provided with relevant information and have the stoma sited correctly by a registered nurse with a defined level of competency

Post-operative stoma care management (practical)

Patient with newly formed stoma are assessed by a SCN and an individualised stoma care plan formulated

Post-operative stoma care management (psychological)

Patient with a newly formed stoma is assessed by the SCN and an individualised stoma care plan is formulated

Preparation for discharge from hospital

Patient with a newly formed a stoma is provided with the appropriate information to facilitate discharge from hospital

Short term specialist SCN up to 3months

Patient with a newly formed stoma will receive appropriate continuity of care by ta SCN after discharge from hospital

Long term specialist SCN support Patient living with a stoma have continued care and access to a SCN

Method: Patients were contacted one month after discharge from hospital and a telephone interview conducted using the ASCN (2015) audit questionnaire. The data was analysed and presented to the team and an action plan agreed.

Conclusion: The audit demonstrated that although we are providing a good quality service in many areas there are several areas that could be improved upon. Using the results the team have been able to agree an action as to how these areas can be addressed.

Results: Results highlighted that although there were many areas of good practice there were also some areas that needed improving upon. These are that all patients should be offered the opportunity to meet another stoma patient pre-operatively, that they need to be aware of having an individualised care plan and of potential stoma complications prior to discharge home. Also patients need to be given sufficient time to discuss how they feel emotionally about having a stoma and provided with information about relevant support groups and information regarding any changes to their prescription.

Ab

stra

ctM

eth

od

Su

mm

ary

of

ind

ing

sA

ctio

n P

lan

Dansac Tele Homecare• Support service for patients to make the transition from hospital to home.

• Trained advisors call patients daily for first 10 days at home, providing reassurance and practical advice.

• Support with phone calls continues at 3, 6 and 12 months.

Patient Progress Diary • Individualised care plan for patients using RAG (red, amber,

green) rating to guide patients to self care.

• At each postoperative visit, nurse completes indicating patients progress with learning how to change their appliance.

• Diary also includes written details of patient support groups.

How good is the stoma care service we provide?

In 18 out of 26 questions patients scored over 80% positive responses and thus demonstrates that a good quality service is provided in the following areas:

Patients feel that they are:• Involved in the marking of the stoma site and agree the site pre-operatively• Given adequate verbal and written information to decide about stoma surgery• Given an opportunity to discuss lifestyle issues• Able to manage their stoma care on discharge and assisted in choosing the right stoma products• Given the opportunity to have their family included in their stoma care• Provided with sufficient supplies on discharge• Felt that any complications they have had have been dealt with efficiently• Felt comfortable to discuss issues relating to changed body image and sex• Felt that the local SCN is approachable and can be easily contacted

However, there were several areas where patients scored less than 80%

Patients felt that they were not always:

• Offered the opportunity to meet another stoma patient pre-operatively

• Aware of having an indivualised care plan

• Supported and encouraged by all ward staff

• Aware of potential stoma complications prior to discharge home

• Given sufficient time to discuss how they feel emotionally about having a stoma

• Provided with information about relevant support groups (local patients)

• Supported by district nurses (when appropriate)

• Provided with information regarding any changes to their prescription.

In addition, some patients were being provided with excess appliances and accessories.

Action required Actions to be implemented and change in practice

Patients to be given opportunity to meet another stoma patient pre-operatively

• Written details of ileostomy, colostomy and urostomy association or if local ‘inside out’ group to be included in pre op packs• Information to be included in planned new patient book (currently being written)

Patients to be aware of an individualised care plan

• Pilot of new ‘Patient Progress Diary’ using RAG (red, amber, green) rating to demonstrate progress towards self-care (green indicates patient ready for discharge)• To encourage ownership, booklet is kept with stoma supplies

Patients to be supported and encouraged by all ward staff

• Lead nurse to feed back to matron to disseminate audit results and comments at relevant team meetings• Continue with ward teaching programme• Ward staff orientation to include time working with stoma care team

Patients to be aware of potential stoma complications prior to discharge home

• Team to explain to patients the most common complications they may experience prior to discharge (i.e. leakage, sore skin, blockage, constipation)• All patients to be given a discharge information pack including booklets on diet and avoiding hernia

Patients to be given adequate time to discuss how they feel emotionally about having a stoma particularly when they are first discharged home

• Pilot of Tele Homecare service to provide patients with additional emotional support in first 10 days after discharge• At each clinic visit SCN to enquire how patient feeling emotionally

Local patients to be provided with information about relevant support groups post operatively

• Written information and contact details for patient support groups and for local patients ‘inside out’ group included in new ‘Patient Progress Diary’ which patients will take home with them

Local patients to be supported by district nurse (when appropriate)

• Lead nurse to feed back to community nurse managers to disseminate audit results at relevant team meetings• Offer programme of stoma teaching for community nurses

Patients are not to be provided with excess appliances and accessories

• Highlight at team meeting the importance of following the ASCN guidelines on usage for appliances and accessories• Where multiple accessories are being used the rationale will be explained and communicated to GP

Patients to be provided with information regarding any changes to their prescription • All patients to be copied into all letters sent to GP. Staff training on CIS if required

Supporting your Return Home

100%

PATIENT SATISFACTION

ONGOING SUPPORT &ADVICE

All of the people features in this brochure are real ostomists.

For more information please call a TeleHomecare advisor on

FREEPHONE 0800 328 0777

ADVICE

CARING

SUPPORT

“ I didn’t have any confidence. It felt like my life was over. The advisor listened and allayed my fears.”

“ The day-to-day knowledge that the advisors have is exactly what I needed to help me manage my stoma.”

“ You build up a rapport with your advisor and this makes you feel confident enough to ask the silly questions.”

We would like to thank Sylvie, from East Kent, for her positive feedback on our TeleHomecare service.

Supporting your Return Home

Advice

Caring

Support

100% of patientswere satisfied with theservice received.

97% found

the callsuseful.

97% found

the advicehelpful.

97% of patients said the advisor understoodtheir concerns.

98% of patientsfelt the advisor putthem at ease.

98% felt their advisorhelped with any anxiety.

Above stats taken from anon. survey 2014.

Welcome Home!Dansac TeleHomecare is part of our dedicated patient support team, helping to make your transition from hospital to home as smooth as possible. We liaise with your nursing team to ensure that you have all the help you need.

We know the first few days after your discharge can be daunting as you recover from surgery and adjust to the challenges of life with a stoma. So, our fully trained advisors

will call you daily during your first ten days at home, providing reassurance and practical advice on managing your stoma in the most effective way.

We will also continue to offer you support with phone calls at three, six and twelve months, giving you a helping hand on your journey to recovery.

Laura

Senior Customer Services Advisor

Fully trained professional advisors

Daily phone calls for your first ten days* at home and you can call our friendly team for advice anytime t

Dietary and product advice, living, travelling and how to care for your stoma

*Applies to first 10 working days t Mon-Fri 8:30-5pm

“ I didn’t have any confidence. It felt like

my life was over. The advisor listened

and allayed my fears.”

“ The day-to-day knowledge that the advisors have is exactly what I needed

to help me manage

my stoma.”

“ You build up a rapport

with your advisor and

this makes you feel confident enough to ask

the silly questions.”

We would like to thank Sylvie, from

East Kent, for her positive feedback

on our TeleHomecare service.

Supporting your Return Home

Advice

Caring

Support

100% of patients

were satisfied with the

service received.

97% found

the callsuseful.

97% found

the advicehelpful.

97% of patients said

the advisor understood

their concerns.

98% of patients

felt the advisor putthem at ease.

98% felt their advisor

helped with any anxiety.

Above stats taken from anon. survey 2014.

Welcome Home!Dansac TeleHomecare is part of our dedicated patient

support team, helping to make your transition from hospital

to home as smooth as possible. We liaise with your nursing

team to ensure that you have all the help you need.

We know the first few days after your discharge can be

daunting as you recover from surgery and adjust to the

challenges of life with a stoma. So, our fully trained advisors

will call you daily during your first ten days at home, providing reassurance and

practical advice on managing your stoma in the most effective way.

We will also continue to offer you support with phone calls at three, six and

twelve months, giving you a helping hand on your journey to recovery.

Laura

Senior Customer Services Advisor

Fully trained professional advisors

Daily phone calls for your first ten days*

at home and you can call our friendly

team for advice anytime t

Dietary and product advice, living,

travelling and how to care for your stoma

*Applies to first 10 working days

t Mon-Fri 8:30-5pm