Implementing a Validated Peristomal Skin Assessment Instrument into Clinical Practice to Facilitate the Provision of Optimal Ostomy Care - Antonini Mario - ECET 2011
Implementing a Validated Peristomal Skin Assessment Instrument into Clinical Practice to Facilitate the Provision of Optimal Ostomy Care Mario Antonini, MS, ET Rehabilitation Center for Ostomy and Wound Care - San Giuseppe Hospital Empoli, Italy SC-000238-IT Symposium and speaker sponsored by ConvaTec
The rehabilitation of peopleliving with an ostomy dependsmainly on the integrity of theirperistomal skin. Maintaining a healthy peristomal skin is therefore, the main objective of any healthcare professional that manages ostomates.
STOMATHERAPY IN ITALY: Panoramic THE STOMATHERAPY IN ITALY • N. of ostomy patients: 60.000 (Source: FAIS - Italian Ostomy Patients Association) • New Procedures/year: 16.000 – 17.000 • N. of ET Centers: 120 • N. of ET Nurses : 300 Ostomy patients in Italy 44,87% Nord Italia 33,78% Centro Italia 21,35% Sud Italia
THE SACS STUDY: Review of the Literature Need for a shared Peer-to-Peer and recognized discussion classification Review of the Literature Peristomal Lesions (Dermatologist)
THE SACS STUDY: Review of the Literature The literature often classifies peristomal skin complications by early or late presentations. Among those, what is described as “skin irritation” has the higher incidence rate. According to Colwell et al. the incidence rate is between 18% and 55%.
THE SACS STUDY: Review of the Literature Type of Ostomy According to my esperience, 33% approximately 1/3 of 67% Colostomates and 2/3 of Ileo-Urostomates suffer from at least one peristomal lesion. Colostomy Ileo-Urostomy
THE SACS STUDY: Review of the Literature 1. Number of participants in each phase of the analysis.Incidence of complicationsof the stoma and peristomal 2. Different length of theskin among individuals with studies.colostomy, ileostomy, andurostomy: a systematicreview. Salvadalena G.Journal Wound Ostomy 3. No definitions of skinContinence Nurs. 2008 Nov- disorders.Dec;35(6):596-607; quiz 608-9. 4. No description of the assessment of the skin lesions.
THE SACS STUDY: Review of the Literature RECOMMENDATION 9 Assess the stoma immediately post-operatively and the stoma/peristomal skin condition with each appliance change using a validated classification tool to monitor for complications. Level of Evidence = IV RECOMMENDATION 10 Identify risk factors that influence stomal and peristomal complications. Level of Evidence = III RECOMMENDATION 17 Assessment and follow-up by an Enterostomal Therapy Nurse (ETN) are recommended for the client and family after ostomy surgery to decrease psychological distress, promote optimal quality of life and prevent complications. Level of Evidence = IIb RECOMMENDATION 18 Educate client and family members to recognize complications affecting the stoma and peristomal skin. Level of Evidence = IV
THE SACS STUDY: Objectives DEFINITION OF THE OBJECTIVE N.1: Assess and PARAMETERS FOR classify peristomal skin disorders. THE RESEARCH: The Study group agreed on not taking into consideration: OBJECTIVE N.2: Evaluate the - The etiology of the correlation between blood peristomal skin chemistry and severity of disorders peristomal lesions. - the therapeutical treatment OBJECTIVE N.3: Diagnosis and treatment of peristomal skin FUTURE STEPS disorders.
End of the SACS StudyOSTOMY CLASSIFICATIONCENTERS OF THE• Rome PERISTOMAL SKIN DISORDERS• Catania• Messina February 2006• Turin 2005 2004 December OSTOMY June/July 2003 CENTERS 2006 • Bozen Beginning of • Prato the SACS • Empoli Study
Ostomy Patient ENROLLMENT 2* END POINT of the S.A.C.S. SACS Study Study Group 1 Group 2 < 1 year > 1 year ASSESSMENT • General Evaluation Time frames • Blood Chemistry (0, 4, 12, 24 weeks) • PicturesREGISTRATION Consensus Data Analysis with SPSS Conference software Classification of Peristomal Skin Disorders
THE SACS STUDY: DefinitionsPERISTOMAL AREA:The term “peristomal” ismeant to include thewhole skin around thestoma (within 7,5 cm,which is the maximumsize of the skin barriersavailable in the market), 7,5 cm 7,5 cmeven if it is not directlylinked with the stoma.
THE SACS STUDY: DefinitionsTHE PREDOMINANT SIGN:It was decided that theclassification should alwaysrefer to the most severlesion first. Additionallesser lesions can also beclassified as an option toconform to local practice.In general, theclassification shouldinclude only one “L” andone or more “T”.
THE SACS STUDY: ClassificationLESION (L) SACS CLASSIFICATION L1 HYPEREMIC LESION Peristomal redness with intact skin.
THE SACS STUDY: ClassificationLESION (L) SACS CLASSIFICATION L2 EROSIVE LESION Open lesion NOT extending into subcutaneous tissue; partial thickness skin loss.
THE SACS STUDY: ClassificationLESION (L) SACS CLASSIFICATION L3 ULCERATIVE LESION Open lesion extending into subcutaneous tissue and below; full thickness skin loss.
THE SACS STUDY: ClassificationLESION (L) SACS CLASSIFICATION L4 ULCERATIVE LESION Full thickness skin loss with non-viable, dead tissue (necrotic, fibrinous).
THE SACS STUDY: TopographyTOPOGRAPHY (T) Patient standing in front of the HCP - I = Upper Left Quadrant - II = Upper Right Quadrant -III = Lower Right Quadrant - IV = Lower Left Quadrant - V = All the QuadrantsPerspective of the HCPThe order of the quadrants around the stomastarts in the Upper Left corner (TI) and ends in theLower Left corner (TIV) clockwise.
THE SACS STUDY: One Instrument, two approaches TI TII TIV TI TV TV TIV TIII TIII TII
THE SACS STUDY: Example Of Classification MOST SEVERE LESION L3 Open lesion extending into subcutaneous tissue TOPOGRAPHY TIII - IV (Quadrants III and IV) CLASSIFICATION L3, TIII-IV
THE SACS STUDY: In Europe Requests of further info about the study Requests of partecipation in the study Translation in many other languages
THE SACS STUDY: In Italy • Nursing Management of Peristomal LesionsEducation & Training for Nurses • Tissue Repair and Ostomy Training Sessions • University Training CoursesInsertion in Hospital Protocols • ET Centers involved • Hospitals in Central & Northern Italy • ConvaBaseTools to facilitate the use of the Classification • Brochure & Ruler
THE SACS STUDY: San Giuseppe Hospital –Empoli (Italy)
"Helm, full ahead," she orders. "Lets see whats on the other side." Like another explorer centuries before her, who stood on the brink of an equal adventure, her eyes blur with tears even as shelaughs, the reason for either response a mystery to her, rooted deep in that which makes her human. For even here, even now, the adventure is still just beginning .... JUDITH AND GARFIELD REEVES-STEVENS “Timone avanti tutta,” ordina. “Vediamo cosa c’è dall’altra parte.” Come un altro esploratore vissuto secoli prima della sua epoca, all’inizio di una identica avventura, I suoi occhi si velano di lacrime mentre ride; la ragione di entrambe quelle reazioni rimane un mistero per lei, per quanto sia radicata in profondità in ciò che la rende umana. Poichè perfino qui, perfino adesso, l’avventura non è che all’inizio… JUDITH AND GARFIELD REEVES-STEVENS
Authors:• Mario Antonini• Giovanna Bosio• Luigi Lucibello• Francesco Pisani• Antonino Fonti• M. Assunta Scrocca• Gaetano Militello• Christa Morandell GRAZIE per• Laura Anselmi• Stefano Gasperini l’attenzione!• Diego Mastronicola
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