The Ostomy Skin Tool –2.rész workshop

The Ostomy Skin Tool Workshop and case studies ESET TANULMÁNYOK Anna Monika Tomanek Clinical Advisor

Meeting objectives CÉLKITŰZÉS Workshop 1 – simple case EGYSZERŰ Workshop 2 - complex case ÖSSZETETT Using the Ostomy Skin Tool in practice GYAKORLÁS   

Workshops: 2 cases /2 ESET •Plenary: Introduction to the cases BEVEZETÉS •Workshop: MŰHELYMUNKA •Review case study with histories and photographs TÖRTÉNET+FOTÓ •Assess the case using the Ostomy Skin Tool- DIAGNÓZIS •Discuss with colleagues in your group - MEGBESZÉLÉS •Plenary: Voting and Discussion SZAVAZÁS+ VITA

Case 1Case 1: Visit 1

Domain 1: Discolouration ELSZÍNEZŐDÉS •Area score = ? TERÜLETI PONT •Severity score = ? SÚLYOSSÁGI PONT

Domain 1: Discolouration ELSZÍNEZŐDÉS •Area score TERÜLETI PONT= 1 •Severity score SÚLYOSSÁGI PONT = ?

Domain 1: Discolouration ELSZÍNEZŐDÉS •Area score = 1 TERÜLETI PONT •Severity score = 2 SÚLYOSSÁGI PONT

Domain 2: Erosion FELMARÓDÁS •Area score = ? TERÜLETI PONT •Severity score = ? SÚLYOSSÁG

Domain 2: Erosion •Area score = 1 •Severity score = ?

Domain 2: Erosion •Area score = 1 •Severity score = 2

Domain 3: Tissue overgrowth KINÖVÉSEK •Area score = ? TERÜLETI PONT •Severity score = ? SÚLYOSSÁG

Domain 3: Tissue overgrowth •Area score = 0 •Severity score = ?

Domain 3: Tissue overgrowth •Area score = 0 •Severity score = 0

Summary of case 1: Total DET score PONT ÖSSZESÍTÉS TOTAL = 6 Area TERÜ- LET Severity SÚLYOSSÁ G Total D E T DET score 6

Case 1: Using the DET score Case 2: Visit 1

Case 2: Visit 1 2.ESET 1. VIZIT •Background information: HÁTTÉR INFO •Sex: Male FÉRFI •Age: 67 years old KORA 67 ÉV •Reason for stoma creation: Diverticulitis •Type of stoma: Colostomy •Average adhesive wear time: 2 days ESZKÖZT CSERÉL 2 NAPONTA

Domain 1: Discolouration ELSZÍNEZŐDÉS •Area score = ? TERÜLETI PONT •Severity score = ? SÚLYOSSÁG Visit 1

Domain 1: Discolouration •Area score = 2 •Severity score = ? Visit 1

Domain 1: Discolouration •Area score = 2 •Severity score = 1 Visit 1

Domain 2: Erosion FELMARÓDÁS •Area score = ? TERÜLETI PONT •Severity score = ? SÚLYOSSÁG Visit 1

Domain 2: Erosion •Area score = 2 •Severity score = ? Visit 1

Domain 2: Erosion •Area score = 2 •Severity score = 1 Visit 1

Domain 3: Tissue overgrowth KINÖVÉSEK •Area score = ? TERÜLETI PONT •Severity score = ? SÚLYOSSÁG Visit 1

Domain 3: Tissue overgrowth •Area score = 1 •Severity score = ? Visit 1

Domain 3: Tissue overgrowth •Area score = 1 •Severity score = 2 Visit 1

Summary of case 1 at Visit 1: Total DET score ÖSSZESÍTŐ TOTAL = 9 Area TERÜ- LET Severity SÚLYOSSÁG Total D E T DET score 9

Case2: Visit 2

Domain 1: Discolouration ELSZÍNEZŐDÉS •TERÜLETE •Area score = ? •Severity score = ? SÚLYOSSÁGA Visit 2

Domain 1: Discolouration •Area score = 1 •Severity score = ? Visit 2

Domain 1: Discolouration •Area score = 1 •Severity score = 1 Visit 2

Domain 2: Erosion FELMARÓDÁS Visit 2 •Area score = ? TERÜLETI PONT •Severity score = ? SÚLYOSSÁG

Domain 2: Erosion Visit 2 •Area score = 1 •Severity score = ?

Domain 2: Erosion Visit 2 •Area score = 1 •Severity score = 1

Domain 3: Tissue overgrowth KINÖVÉSEK Visit 2 •Area score = ? TERÜLETI PONT •Severity score = ? SÚLYOSSÁG

Domain 3: Tissue overgrowth Visit 2 •Area score = 1 •Severity score = ?

Domain 3: Tissue overgrowth Visit 2 •Area score = 1 •Severity score = 1

Summary of case 2 at Visit 2: 2.ESET 2. VIZIT Total DET score ÖSSESÍTŐ TOTAL = 6 Area TERÜ -LET Severity SÚLYOSSÁG Total D E T DET score 6

Summary of case 2 ÖSSZEFOGLALÁS 2. ESET TOTAL = 9 TOTAL = 6 Visit 1 Visit 2

The Ostomy Skin Tool Using the Ostomy Skin Tool in practice – A GYAKORLATBAN

Patient and case study ESETTANULMÁNY •69-year-old woman 69 ÉVES NŐBETEG •Emergency surgery for a bowel infection and had an ileostomy SÜRGŐSSÉGI MŰTÉT, BÉLFERTŐZÉS, ILEOSTOMA Case history •Day 14 after surgery, ostomy appliance found leaking and causing patient distress 14 MÚLVA SZIVÁRGÁS AZ ESZKÖZNÉL… •Using the Ostomy Skin Tool, a DET score of 4 was calculated PONTSZÁMA DET 4

Area TER Severity SÚLYOS. Total D112 E112 T000 DET score4 Assessment 1 DET score 1.VIZSGÁLAT PONTSZÁMA

Visit 2 •At the return visit 13 days later, the DET score was 2 •13 NAP MÚLVA PONTSZÁMA DET 2 •The appliance was adhering; the patient was not experiencing peristomal skin discomfort and she was much happier •JÓL TAPAD AZ ESZKÖZ •By using the DET score, whichever nurse saw the patient on subsequent visits had a clear and uniform way to evaluate the peristomal skin and decide if it was improving or deteriorating, providing seamless patient care •BÁRKI LÁTTA EL, AZONOS MÓDON ÉRTÉKELTE A JAVULÁST

Area TER. Severity SÚLYOS. Total D112 E000 T000 DET score2 Assessment 2 DET score 2.VIZSGÁLAT DET PONTOK

Patient and case history ESET TANULMÁNY The patient: Mr M •69-year-old man with Crohn’s disease 69 ÉVES FFI CHRON B. •Abdominal perineal resection with ileostomy in 1998 •No extraintestinal manifestations Case history •Recent onset of peristomal ulcerations STOMA KÖRÜL FEKÉLY •Two visits to emergency department 2 SÜRGŐSSÉGI VIZIT •Presented to the clinic in “excruciating” pain FÁJDALMA 10-ES •Pain rating 10 out of 10

Visit 1 Pyoderma gangrenosum (PPG) Example of PPG Area TER. Severity SÚLYOSSÁG Total D325 E325 T000 DET score10 Assessment 1 DET score Baseline ALAPADAT

Area TER. Severity SÚLYOSSÁG Total D224 E325 T000 DET score9 Area TER. Severity SÚLYOSSÁG Total D213 E224 T000 DET score7 Visits 2 and 3 Assessment 2 DET score Week 2. HÉT Assessment 3 DET score Week 4. HÉT Pain rating 8 out of 10 FÁJDALOM INDEX 8 Pain rating 6 out of 10 FÁJDALOM INDEX 6

Justifying Mr M’s care BIZONYÍTÁS •Administrators were concerned about the time and resources used IDŐ, KÖLTSÉG •Claimed Mr M was “clearly no longer a hospital patient ” •Ostomy care nurse reviewed the case with the administrators •Lack of community resources and emergency care inappropriate FORRÁSHIÁNY •Used DET scores to show severity of disorder and effect of appropriate treatments and expert management DOKUMENTÁLT KEZELÉSI EREDMÉNYEK

It is not just what you know that creates Best Practice… NEM AZ JÓ PÉLDA, AMIT TUDSZ, CSAK AZ, AMIT MEGTESZEL!!! It is what you do that creates Best Practice!!! Slide Courtesy Dr. Sibbald REMEMBER: EMLÉKEZZ:

Thank you KÖSZÖNÖM Anna Monika Tomanek Clinical Advisor