Group Pre-operative Ostomy Education Class: Improves Satisfaction, Decreases Complications, and Reduces Cost

Purpose:
Many of our ostomy patients had frequent hospital readmissions. Reasons for readmission include dehydration, obstruction and lack of knowledge in caring for their ostomy. Anxiety, anesthesia, nausea and pain affect their ability to comprehend any education which normally occurs postoperatively.

Relevance/Significance:
The preoperative group ostomy education class has enhanced patient satisfaction, decrease complications, and has allowed patients to better prepare for lifestyle changes associated with having an ostomy.

Strategy and Implementation:
An interdisciplinary team of care coordination, colorectal surgeon and CWOCN team met to augment the usual care with an innovative weekly 1 hour group ostomy education class that is provided pre operatively. The goals of the class are to decrease patient anxiety, decrease hospital length of stay, prevent hospital readmission (within 30 days), promote quality patient outcomes, improve patient satisfaction, and improved WOC Nurse expertise and utilization of time. An interdisciplinary team of CWOCN, RN Care Coordinator and Nutritionist provide education. A video is shown that instructs on basic anatomy and care of the ostomy, then the CWOCN reviews key points of the video which include use of stomahesive powder, no sting skin prep, cohesive rings. The patient applies pouch to a "fake stoma". Care coordination explains expectation of hospital and transition to home care. Nutritionist discusses the progression of dietary needs and important of maintaining adequate nutrition and hydration.

Evaluation:
We compared outcomes of participants in group education classes with a control group obtained retrospectively from the year prior to initiation the group education. A decrease of 24.5% in peristomal complications, Length of stay decreased by 1 day and readmissions decreased by 5% for patients who attended class. By completing class the patient can concentrate on recovery.

Implications for Practice:
Patients that do not attend ostomy class and must be educated post operatively, have decreased retention of the education. Therefore, we find that those patients are more likely to be readmitted to the hospital, increased chance of stomal/pouching complications and require more nursing care.