Artikel
Increasing the rates of preoperative stoma site marking in patients with intestinal ostomy: an implementation project
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Autoren
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Charlotte M Kugler
- Institut für Versorgungs- und Gesundheitssystemforschung (IVGF), Medizinische Hochschule Brandenburg (Theodor Fontane), Rüdersdorf bei Berlin, Deutschland; Zentrum für Versorgungsforschung, Medizinische Hochschule Brandenburg (Theodor Fontane), Rüdersdorf bei Berlin, Deutschland
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Eni Shehu
- Institut für Versorgungs- und Gesundheitssystemforschung (IVGF), Medizinische Hochschule Brandenburg (Theodor Fontane), Rüdersdorf bei Berlin, Deutschland; Zentrum für Versorgungsforschung, Medizinische Hochschule Brandenburg (Theodor Fontane), Rüdersdorf bei Berlin, Deutschland; Evidence Based Practice in Brandenburg: A JBI Affiliated Group, University of Adelaide, Brandenburg a. d. Havel, Deutschland
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Lena Fischer
- Institut für Versorgungs- und Gesundheitssystemforschung (IVGF), Medizinische Hochschule Brandenburg (Theodor Fontane), Rüdersdorf bei Berlin, Deutschland; Zentrum für Versorgungsforschung, Medizinische Hochschule Brandenburg (Theodor Fontane), Rüdersdorf bei Berlin, Deutschland
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Hendrik Christian Albrecht
- Klinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Ruppin-Brandenburg (ukrb), Neuruppin, Deutschland
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Stephan Gretschel
- Klinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Ruppin-Brandenburg (ukrb), Neuruppin, Deutschland
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Colin M. Krüger
- Abteilung für Chirurgie, Immanuel Klinik Rüdersdorf, Rüdersdorf bei Berlin, Deutschland
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Francesco Leggio
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Brandenburg an der Havel, Brandenburg a. d. Havel, Deutschland
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René Mantke
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Brandenburg an der Havel, Brandenburg a. d. Havel, Deutschland; Fakultät für Gesundheitswissenschaften, Medizinische Hochschule Brandenburg (Theodor Fontane), Brandenburg a. d. Havel, Deutschland
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Oskar Rückbeil
- Abteilung für Chirurgie, Immanuel Klinik Rüdersdorf, Rüdersdorf bei Berlin, Deutschland
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Christoph Paasch
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Brandenburg an der Havel, Brandenburg a. d. Havel, Deutschland
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Mateusz Trawa
- Klinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Ruppin-Brandenburg (ukrb), Neuruppin, Deutschland
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Dawid Pieper
- Institut für Versorgungs- und Gesundheitssystemforschung (IVGF), Medizinische Hochschule Brandenburg (Theodor Fontane), Rüdersdorf bei Berlin, Deutschland; Zentrum für Versorgungsforschung, Medizinische Hochschule Brandenburg (Theodor Fontane), Rüdersdorf bei Berlin, Deutschland; Evidence Based Practice in Brandenburg: A JBI Affiliated Group, University of Adelaide, Brandenburg a. d. Havel, Deutschland
| Veröffentlicht: | 10. September 2024 |
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Gliederung
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Background: An intestinal ostomy is an artificial bowel opening created on the skin. According to the JBI evidence summary, preoperative stoma site marking is a strongly recommended practice (grade A) for preventing peristomal complications and for improving the quality of life of patients. However, there are almost no statistics regarding the frequency of preoperative stoma site marking across different hospitals in Germany.
Objective: The aim of this study was to develop a strategy to increase the rate of preoperative stoma site marking in three hospitals at Brandenburg Medical School.
Methods: The primary outcome was the preoperative stoma site marking rate. The project was based on the JBI Evidence Implementation framework and was grounded on the audit and feedback process. It consisted of the following seven stages:
- 1.
- evidence identification,
- 2.
- stakeholder identification and involvement,
- 3.
- situational analysis of context,
- 4.
- baseline audit of the preoperative stoma site marking rate by filtering the cases within the patient management system by OPS codes of intestinal ostomies
- 5.
- implementation of the developed strategy into practice,
- 6.
- follow-up audit after one year, and
- 7.
- consideration of the sustainability of practice changes.
Results: Baseline audit revealed the following marking rates: 163 of 305 cases (53%) were marked across the three clinics between 2017 to 2022 although not all clinics reported data for five years. Elective cases were more often marked (145 of 200, 73%) than emergency cases (18 of 105, 17%) and differences between the three clinics existed. For emergencies, stakeholders reported patient’s physical condition, lack of time, missing knowledge of other professionals and memory as barriers. For elective cases, the reported barriers were uncertainty in documentation and information as well as communication (with nurses and residents). In each clinic, workshops with surgeons, who were responsible that stoma site making was performed, were conducted. The follow-up one year after the workshops (evaluating 2023) demonstrated the following marking rates: in total, 86 of 173 cases (50%) were marked. Again, marking rates of elective cases (57 of 80, 71%) were higher than for emergency cases (29 of 93, 31%). Only in one of three clinics, the stoma marking rate increased after the workshop.
Implication for research and/or (healthcare) practice: The rate of preoperative stoma site marking could not be increased by an audit and feedback approach. Possibly, one workshop may not be sufficient, especially with fluctuations within professionals. Electronic patient data were not complete regarding preoperative stoma site marking since there was no standardised documentation but free text fields instead (e.g. surgery report). Therefore, data extraction was time consuming and there may have been differences in extracting the data. Still, discussing the actual rate per clinic during workshops with surgeons helped to increase importance and awareness within their own clinic. It should be notes, that 100% marking will not be reached since it is not always clear before an (emergency) surgery, if the patient will receive an ostomy. Therefore, criteria which patients should be marked should be agreed on. Alternative implementation strategies, such as a mandatory note within the standardized informed consent form, should be explored to increase preoperative stoma site marking in Germany which could increase quality of stoma patients’ lives.
