The Ostomy Files: The Importance of Coordinating Ostomy Care and Teaching Across Settings

   Ostomy rehabilitation is dependent on the mastery of self-care.¹ The mastery of self-care is dependent on the quality, quantity, and consistency of patient teaching. In addition to being an essential element of ostomy rehabilitation, patient education is also a mandatory requirement of accrediting agencies, insurer payment and coverage policies, and nationally accepted clinical practice guidelines.

   The process of teaching ostomy patients has changed dramatically for the patient, the caregiver, and the healthcare professional. Decreased hospital stays, early discharge for continued recovery, and insurer's coverage and payment constraints all add to the stress and intensity of ostomy surgery. These factors interfere with the continuity of teaching ? influencing who does the teaching and limiting the time available to do it. Today, most ostomy teaching is provided by nonspecialized clinicians who may not be familiar with state-of-the-art care and new products and technologies and who may be lacking the necessary insight to provide cost-effective ostomy care.

   Ostomy teaching begins in the hospital with the bedside nurse and is quickly transferred to the home health agency, long-term care facility, the ostomy retailer, or simply overlooked due to a lethal combination of staff shortages, time constraints, and a failure to assign responsibility for patient education. Frequently, healthcare providers assume that the responsibility for teaching is someone else's in another setting. This unfortunate lack of coordinated communication frequently leaves the ostomy patient to find information and solve management problems on his or her own.

   Some of the biggest teaching challenges often exist inside a single organization, but more often occur between referring institutions. One provider may teach a patient one way of doing something, while the referring organization uses a completely different ostomy supply and teaches the patient contrary information, resulting in minimal or fragmented teaching. This lengthens rehabilitation time and increases provider costs as well as the patient's emotional wear and tear. If standardized teaching plans, linked to a formulary of ostomy supplies, are established organization-wide and coordinated between referring institutions, continuity is promoted, rehabilitation time is compressed, and valuable dollars and clinical days of treatment can be salvaged.

   In the midst of the fragmentation, one constant exists in all settings: Quality, cost-effective care and teaching must be delivered in a short period of time. A structured, strategic, well-designed teaching plan should be developed for ostomy patients and their caregivers in every healthcare setting and coordinated with referring organizations.

   Many factors impact the learner's ability to learn and absorb material. Some of the most significant are the location of the patient; the issues dealt with in that setting; and the patient's emotional, physical, and psychological status at the time. Due to the rapid rate with which patients move through the continuum, it is nearly impossible for all the necessary teaching to be accomplished by one individual in one setting.

   Regardless of the setting, however, each ostomy teaching plan should include some aspect of the following content:
   - The etiology and pathology of the patient's medical condition which led to ostomy surgery
   - Stomal construction
   - Application, care, and removal of ostomy supplies used by the patient
   - Nutrition guidelines (daily fluid intake, applicable dietary restrictions)
   - Care of the stoma and peristomal skin
   - Activities of daily living (bathing, clothing, employment)
   - Sexuality
   - Available resources (healthcare professionals, support groups, printed materials, ostomy retailers, manufacturer's customer service).

   As the patient moves through the continuum and the rehabilitation process, various issues surface and resurface at different times, with varying levels of importance to the patient. Clinicians must identify the most critical content to be taught in the patient's current setting in the allotted time available. The tables included here outline some key patient issues, needs, and concerns, and some suggested nursing actions and required educational content unique to each setting.

   More than ever before, healthcare providers must take a proactive approach to patient teaching as a strategy in compressing rehabilitation time and reducing the overall cost of care.

The Ostomy Files is made possible through the support of ConvaTec, A Bristol-Myers Squibb Company, Princeton, NJ.

1. Erwin-Toth P, Doughty DB. Principles and procedures of stomal management. In: Hampton BG, Bryant RA, Eds. Ostomies and Continent Diversions: Nursing Management. St. Louis, Mo.: Mosby Year Book, 1992:29-103.