Cath Lab Digest

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     Caring for people with intimate healthcare needs such as an ostomy is a great responsibility. Traditionally, ostomy clinicians learn the tricks-of-the-trade from preceptors, mentors, and patients. But as in all of medicine and nursing, as we strive for better outcomes we recognize the need to rely on the scientific method to provide improved, consistent results. Reviewing the literature for information on ostomy issues presents additional challenges because study results reflect differing methods of assessment and data collected and many variables, confounding the evidence base.

     Using a valid and reliable standardized tool to assess a condition has been shown repeatedly to lead to improved outcomes. By speaking the same language, we can decrease variables in our data collection. Several ostomy assessment tools have been developed over the years, but no single tool has been accepted as a standard. To address this concern, international leaders in ostomy were brought together to develop an ostomy peristomal skin assessment tool that was presented at the World Council of Enterostomal Therapists in 2008. The tool was designed in association with the Coloplast (Minneapolis, MN) Global Advisory Board.

The Ostomy Skin Tool

     The Ostomy Skin Tool is designed to establish the condition of the peristomal skin at the time of the consultation (see Tool). It can measure improvement or degradation of skin between consultations and can help cut down the amount of time it takes a nurse to evaluate a disorder, how it occurred, and how it is to be treated. The tool is meant to be used by stoma care nurses for the evaluation of peristomal skin — it is not meant to predict the skin deterioration or to predict the occurrence of a skin disorder.

     The Ostomy Skin Tool is used to assess peristomal skin disorders in two ways. First, it determines a score based on physical assessment of discoloration, erosion, and tissue overgrowth (DET). With the help of pictorial references, a score is assigned for area affected and severity for each domain. Upon reassessment of the condition, improvement or deterioration can be determined by a change in score. The Tool also provides a diagnostic guide that directs the caregiver through an interview with the patient to determine the possible causes of the skin disorder, which can be due to chemical irritation, mechanical irritation, disease, infection, or “other”.

     The tool has been shown to be valid and reliable among ostomy nurses.¹ It has been used as the peristomal skin assessment tool in the DialogueStudy, a multinational clinical ostomy research study examining skin conditions and quality of life in people with ostomies, which concluded in the US in 2009 and will be concluding globally in 2010. The Tool will undergo further validation in a separate study.

     Having a tool that allows the clinician to assess and document peristomal skin disorders in a consistent manner can aid in our understanding of the actual prevalence of peristomal skin conditions. Plus, a tool that assesses adjustment to life with a stoma is necessary to determine if our interventions make an impact on the person living with a stoma.

The Ostomy Quality-of-Life Tool

     A second tool for use in your ostomy practice is a questionnaire for your patients. The Ostomy Quality-of-Life Tool (Stoma QoL) was developed and validated specifically for people with an ostomy.