WCET™ IOG recommendations.
Foundation principles
The WCET™ IOG Panel believes it is good practice to use a patient-centred and holistic care model. This is best achieved by forming a collaborative partnership with the individual preparing for or living with a stoma and their caregivers.
GOOD PRACTICE STATEMENT
Recommendation 1
The WCET™ IOG Panel believes it is good practice to deliver care for the individual living with a stoma using a model of cultural competency.
GOOD PRACTICE STATEMENT
Recommendation 2
The WCET™ IOG Panel believes it is good practice to deliver care for the individual living with a stoma using a biopsychosocial approach.
GOOD PRACTICE STATEMENT
Recommendation 3
The WCET™ IOG Panel believes it is good practice to care for individuals living with a stoma using a collaborative care approach.
GOOD PRACTICE STATEMENT
Recommendation 4
The WCET™ IOG Panel believes it is good practice for stomal care to be provided under the supervision of a nurse who has completed a national/internationally recognised course in stomal therapy.
GOOD PRACTICE STATEMENT
Recommendation 5
The WCET™ IOG Panel believes it is good practice to maintain an inclusive, documented record of the individual’s care.
GOOD PRACTICE STATEMENT
Recommendation 6
Quality of life, mental health and sexuality
The WCET™ IOG Panel recommends that a comprehensive assessment of quality of life and psychosocial health is conducted for individuals living with a stoma. An assessment should evaluate personal characteristics and ostomy-related factors, and the following quality of life domains:
physical health,
psychological health,
level of independence,
social relations,
environment and
spirituality, religion and personal beliefs.
STRONG RECOMMENDATION; Strength of Evidence: B
Recommendation 7
The WCET™ IOG Panel recommends using a stoma-specific QOL assessment tool that has been tested for reliability and validity as a part of a comprehensive quality of life assessment.
STRONG RECOMMENDATION; Strength of Evidence: B
Recommendation 8
The WCET™ IOG Panel suggests implementing multicomponent, individualised intervention/s designed to promote and increase quality of life for individuals living with a stoma. Select the most appropriate components with consideration to the individual’s needs, preferences and goals of care.
CONDITIONAL RECOMMENDATION; Strength of Evidence: B
Recommendation 9
The WCET™ IOG panel believes it is good practice to provide or facilitate access to education and counselling to address sexuality-related issues associated with having a stoma, based on a comprehensive assessment of the individual’s background, needs, preferences and goals of care.
GOOD PRACTICE STATEMENT
Recommendation 10
Knowledge, skills and ability to self-care
Recommendation 11
The WCET™ IOG Panel suggests using a tool that has been tested for reliability and validity to assess self-care ability.
CONDITIONAL RECOMMENDATION; Strength of Evidence: C
Recommendation 12
The WCET™ IOG Panel recommends individuals who are expecting a stoma formation and their caregivers receive education and psychosocial support commencing as early as possible in the ostomy care pathway and continuing through the perioperative period, discharge planning and ongoing stages of care.
STRONG RECOMMENDATION; Strength of Evidence: A
Pre-operative care
The WCET™ IOG Panel recommends that a comprehensive and holistic pre-operative assessment be conducted for individuals undergoing surgery in which stoma formation is expected. Assessment tools that are valid, reliable and appropriate to the individual’s clinical profile and surgical setting should be used to facilitate a comprehensive approach to pre-assessment.
STRONG RECOMMENDATION; Strength of Evidence: B
Recommendation 13
The WCET™ IOG Panel recommends that a structured, disease-specific, peri-operative care protocol be implemented for individuals who are expecting stoma formation.
STRONG RECOMMENDATION; Strength of Evidence: B
Recommendation 14
The WCET™ IOG Panel recommends that stomal site marking is performed pre-operatively, wherever possible.
STRONG RECOMMENDATION; Strength of Evidence: A
Recommendation 15
Post-operative and discharge care
The WCET™ IOG Panel recommends conducting post-operative assessments to monitor the individual and their stoma for clinical complications. In undertaking post-operative assessment, use assessment tools that have been tested for reliability and validity in conjunction with clinical judgement. Select an appropriate assessment tool based on the stage of the individual’s care and the type of complications that are present.
STRONG RECOMMENDATION; Strength of Evidence: C
Recommendation 16
The WCET™ IOG Panel recommends when the individual is clinically ready for discharge, final discharge planning:
reinforces knowledge regarding the stoma and its care,
promotes ability to perform or access stoma self-care,
provides information on when and how to access stoma care, advice and products, and
confirms ongoing clinical follow-up arrangements.
STRONG RECOMMENDATION; Strength of Evidence: A
Recommendation 17
Device and product selection
Recommendation 18
The WCET™ IOG panel believes it is good practice to consider the following factors when fitting an ostomy barrier and ostomy pouch:
the profile of the stoma,
the individual’s peristomal body profile,
·security of the pouching system,
condition of the peristomal skin,
stoma output type and volume,
the individual and their carer’s ability to use the product, including consideration to physical, sensory and cognitive function,
accessibility and cost,
the individual’s quality of life, preferences and goals.
GOOD PRACTICE STATEMENT
The WCET™ IOG panel recommends a convex ostomy skin barrier is considered to reduce stomal leakage and to prevent or manage peristomal skin complications based on stoma configuration, body profile and the individual’s needs.
CONDITIONAL RECOMMENDATION; Strength of Evidence: C
Recommendation 19
Ongoing care
The WCET™ IOG panel suggest that individuals living with a gastrointestinal ostomy are offered nutrition screening and/or assessment, counselling and education to facilitate return to a regular, healthy diet. Where possible, this should be provided under the direction of an appropriately qualified member of the collaborative care team.
CONDITIONAL RECOMMENDATION; Strength of Evidence: C
Recommendation 20
The WCET™ IOG Panel suggests that a multi-component step-up management plan for high output stoma be implemented by a collaborative care team. The management plan should include:
identification of potential causes for high stomal output,
nutrition screening and/or assessment,
clinical monitoring,
fluid and electrolyte management,
optimisation of nutrition, food and fluid intake, and eating practices,
education and counselling, and
pharmacological management.
CONDITIONAL RECOMMENDATION; Strength of Evidence: C
Recommendation 21
Recommendation 22
The WCET™ IOG panel believes it is good practice to consider the impact of the presence and function of a stoma when prescribing and managing the individual’s general medication. This includes the:
impact of the stoma on absorption of the drug,
risk of sub-therapeutic drug levels, and
potential adverse effects.
GOOD PRACTICE STATEMENT
Common stomal complications
The WCET™ IOG Panel recommends using tools designed to assess peristomal skin complications that have been tested for reliability and validity, in conjunction with clinical judgement.
STRONG RECOMMENDATION; Strength of Evidence: C
Recommendation 23
The WCET™ IOG Panel believes it is good practice to implement the following non-surgical strategies to prevent and/or manage common peristomal and stomal complications:
regularly remeasure the stoma in lying, sitting and standing positions,
adjust stomal appliance selection based on the individual’s needs,
recommend the use of an appropriately fitted support garment (as needed),
evaluate stomal function,
provide the individual and their caregiver with information and support, and
refer to the collaborative care team as appropriate.
GOOD PRACTICE STATEMENT
Recommendation 24
The WCET™ IOG Panel suggests encouraging individuals with a stoma to participate in abdominal strengthening exercises commencing before or soon after surgery, under the guidance of an appropriately qualified health professional.
CONDITIONAL RECOMMENDATION; Strength of Evidence: B
Recommendation 25