Increasing rate of pre-operative stoma site marking in patients with intestinal ostomy (INSTOSI): a best practice implementation project

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INTRODUCTION: Pre-operative stoma site marking is a strongly recommended practice for preventing complications and improving the health-related quality of life of intestinal stoma patients. Despite its benefits, this practice is not routinely implemented in clinical practice. OBJECTIVES: This study aimed to increase the rate of pre-operative stoma site marking. METHODS: This evidence implementation project was conducted in three hospitals at the Brandenburg Medical School, Germany. The project followed the seven-stage JBI audit and feedback process recommended in the JBI Evidence Implementation Framework: (1) identification of practice area for change, (2) stakeholder involvement, (3) situational analysis of context, (4) baseline audit of stoma site marking rate, (5) strategy implementation (workshops with surgeons in each hospital to discuss baseline results), (6) 1-year follow-up audit, and (7) assessing the sustainability of practice changes. RESULTS: The baseline audit revealed the following marking rates: 163 of 305 cases (53%) were marked across the three hospitals between 2017 and 2022. Elective cases were more often marked (145 of 200, 73%) than emergency cases (18 of 105, 17%). Barriers included poor physical state of emergency patients, lack of time, memory recall, and communication issues between surgeons and nurses. At follow-up 1 year after the workshops, 86 of 173 cases (50%) were marked (elective cases: 57 of 80, 71%; emergency cases: 29 of 93, 31%). CONCLUSIONS: Audit and feedback did not increase the overall rate of pre-operative stoma site marking, but did improve the rate in emergency cases. A single workshop may be insufficient to effect change. Electronic patient data lacked standardized documentation for pre-operative stoma site marking. SPANISH ABSTRACT: http://links.lww.com/IJEBH/A329.

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