Exploring the Intricacies of Stoma Care Date 25

Exploring the Intricacies of Stoma Care Date: 25 June 2018 Presented by: Bernadette Ambrose Stoma Care Nurse Specialist West Suffolk Community 1

Introduction • • • 2 Some common reasons for stoma formation Overview of the 3 types of stomas The importance of Skin Health ‘p’ Ratings in West Suffolk Accessory usage

Some common reasons for Stoma formation • • 3 Carcinoma (bowel & bladder) Diverticulitis Inflammatory Bowel Disease Familial Polyposis Trauma Neurological damage (M. S. ) Incontinence Congenital Disorders

Colostomy A colostomy is formed from the large bowel Can be permanent or temporary Can be a loop or an end stoma Output is usually formed or soft faeces Generally use a closed bag Pouch change depends on bowel function can be 2 -3 times a day 4

Loop Colostomy 6

Ileostomy • • 7 Formed from the ileum Generally on the R side May be temporary or permanent Loop or end, should be spouted (2. 5 cm) Output – loose, porridge like consistency Use a drainable bag Empty 4 -6 x day and change alternate days

Urostomy • Formed form a section of bowel used to form a conduit into which ureters are attached. • Always permanent, end stoma • Urine will always contains some mucus • Pouch with a tap or a bung • Emptied 5 -6 times a day • Bag changed alternate days 9

The ‘Perfect’ Stoma • Until the advent of the Brookes ileostomy, there was no gold standard for the formation of a spouted ileostomy & ileal conduit. 1 　 • St Marks’ Hospital London UK published a paper written by Celia Myers and Robin Phillips to set the new standard for a slightly spouted colostomy. 2 1. 2. History of Ostomy Surgery – D. Doughty. Journal of Wound, Ostomy, & Continence Nursing Vol. 35, No. 1. 2008 2. Minimally Raised End Colostomy – B. M. Stephenson. , C. Myers, R. K. S. Phillips. International Journal of Colorectal Disease Vol. 10. No. 4. 1995.

Perfect Ileostomy/Urostomy

However ……

The Skin • Largest organ • Divided into 2 Layers – Epidermis – Dermis • Functions – – – Thermoregulation Protection Waterproofing Synthesis of Vit D sensation • Differs in appearance & Structure – Location – Age – Disease

Consequences of a NOT so perfect stoma 15

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The Problematic Stoma • Many people with a stoma may experience complications at some point. • Many factors contribute to a problematic stoma • In 2008 we initiated the ‘P’ Rating system where each stoma formed at the WSH was given a rating depending on the number of accessories required to ensure a secure fit. • The purpose of this was to initiate discussion and help improve the quality of the stomas formed, thereby improving the patients quality of life and reducing the cost in accessory usage.

‘P’ RATINGS - A STOMA GRADING TOOL Grading Number of Accessories Accessory Type Required 0 p 0 N/A 1 p 1 Convex 2 p 2 Convex, belt 3 p 3 Convex, belt, paste 4 p 4 Convex, belt, paste, seals 5 p 5 Convex, belt, paste, seals & extenders

‘p’ Ratings Overview of p 0 – p 1 Stomas 2008 2010 2012 2015 2016 2017 78% 82% 77% 92% 98% In 2017 72% of all stomas formed at the WSH did not require any accessories to achieve the perfect Fit. 19

The Importance of a Good Fit

Conclusion • My role as a Stoma Care nurse explores the intricacies of Stoma Care on a daily basis. • Skin Health is paramount to ensure the patient continues to have the confidence and ability to lead an active and full life following this life changing surgery. 21