The Journal of Stomal Therapy Australia - Australian Association of ...

Survey research considered the rate of skin disorders in
abdominal stoma patients and found that 73% reported the
occurrence of a skin problem, with irritant reactions, pre-existing
skin disorders, seborrhoeic dermatitis and eczema some of the
most frequent skin disorders mentioned 3 .
The occurrence of stoma-specific complications has been
associated with a significantly higher mortality rate 5 . On the
other hand, the involvement of an enterostomal nurse was
associated with a six-fold decrease in stoma complications 4.
Though the prevalence of stoma complications has been
considered in a number of studies, albeit without great consensus
as to the rate and nature of the most common complications, no
published studies could be located that explore the reasons
associated with the need for acute care admission among
individuals living with a stoma. This gap in the literature and
the higher than expected rate of acute care discharges arising
from a profile study of clients living with a stoma and receiving
community nursing care, led to the current study.
Aims and Objectives
The audit study was commenced in 2005 with the aim to
describe the reasons for and circumstances surrounding the
discharge into acute care of community based individuals living
with a stoma, who were receiving community nursing services.
To enable a clinical judgment as to whether the acute readmission
could have been avoided and if so how, the study had a number
of stated objectives that included determining the specific
reason for the discharge into acute care, identifying whether
the discharge was related to the stoma, and reviewing the care
delivered in the community.
While confirming the appropriateness of current practice from a
local perspective, the results of this audit study remain relevant
to the wider ST community by offering a description of the
likely problems to arise for people living with a stoma and
the likely reason for admission to hospital for clients living in
the community. These results will inform preventative care to
ensure that the most common stoma problems encountered in
the community are addressed by health professionals in the
community and acute sectors in an attempt to avoid the onset
of complications.
Method
The ST client profile study identified 63 episodes during the
first six months of 2004 with an acute care discharge from the
community nursing service. A retrospective client care record
(CCR) audit of these stoma clients was conducted. A customised
audit instrument was developed for the audit study. Members
of the ST CLG each contributed to the study by conducting a
proportion of the audits. A series of workshops involving all
of the auditors was conducted to optimise the inter-auditor
reliability.
The audit forms were data entered into SPSS 14.0. The analysis
relied primarily on descriptive statistics though some nonparametric
tests were employed when comparing client groups
on categorical outcome measures. The CLG discussed the results
and the recommendations were collaboratively agreed upon.
Results
An audit of 60 of the 63 episodes identified to have a discharge
into acute care was completed. Three records were not located
within the auditing time frame and so were excluded. The
results are presented as they pertain to the reason for the
discharge, other stoma related problems during the episode, and
staff type and involvement in ST episodes. Valid responses to the
questions are reported.
Approximately 33.3% of clients had a stoma as their primary
diagnosis (23.7% bowel; 8.5% bladder). The remaining clients
had a stoma as a secondary diagnosis, though a matter for
ongoing investigation by the group was the sizable proportion
of clients with a diagnosis not considered by the ST specialists
to be within their scope of care; namely 30% with suprapubic
catheters. Though the suprapubic catheter represents a surgical
opening for the removal of body waste, this care is overseen
by continence specialists within the agency. A series of nursing
activity codes that have served to improve recording of stoma
care interventions were in place at the time of the audit, but had
not been introduced in time for their inclusion in the episodes,
which were audited.
Reasons for discharge
The vast proportion of discharges into acute care for clients
with a stoma was unplanned (81.7%). The discharge was
rarely identified as being in relation to the client’s stoma or
for a planned reversal and 71.7% of episodes were discharged
for other medical reasons. Though small cell sizes prohibited
statistical analysis of this data, the figures shown in Table 1 do
suggest that a greater number of discharges relating to stoma
matters were planned, compared to the proportion of planned
discharges for other medical conditions.
Planned Unplanned Total
discharge Discharge
Planned reversal % 25.0 - 5.0
of stoma (n=) (3) (0) (3)
Other stoma % 25.0 8.3 11.7
related issue (n=) (3) (4) (7)
Other surgery % 8.3 12.5 11.7
related issue (n=) (1) (6) (7)
Other medical % 41.7 79.2 71.7
condition (n=) (5) (38) (43)
TOTAL % 100.0 100.0 100.0
(n=) (12) (48) (60)
* Valid responses – multiple responses per episode may be
recorded
Table 1. Cross tabulation of the reason for discharge and whether the
discharge was planned or unplanned
JOURNAL OF STOMAL THERAPY AUSTRALIA 2007 27(3)