Stoma: Care and Assessment

8 April 2018

Author
Yimei Li, MBBS, MMed, MPH

Question
What is the best evidence regarding care and assessment for people with stomas before and after the
operation?

Clinical Bottom Line

Ostomy is a surgical procedure that allows the external diversion of feces and urine through an abdominal
stoma.1 The stoma refers to the opening of the bowel or urinary system onto the abdomen. The most
common types of stomas include colostomies (formed from a piece of colon), ileostomies (formed from
the ileum), and urostomies or ileal conduits (formed in the urinary tract using a section of ileum).1

• A clinical practice guideline developed by the Registered Nurses’ Association of Ontario (RNAO)
recommends the following for ostomy care and management:1
• Core recommendations:

• A comprehensive assessment of the client/family including history and physical assessment,

psychosocial assessment, and assessment of cultural, spiritual and religious norms (Level 4)
• Interdisciplinary team assessment and intervention as needed (Level 5)
• A mutually acceptable plan of care between the client/family and healthcare providers (Level 4)
• Pre-operative Phase Recommendations

• Pre-operative education for all clients and families requiring ostomy surgery (Level 1)

• Stoma site marking on all clients undergoing ostomy surgery (Level 2)

• Assessment of the potential impact of surgery on intimacy on sexual functioning (Level 1)
• Progressive muscle relaxation therapy should be offered to all clients (Level 1)

• Post-operative Phase Recommendations

• Assessment of the stoma immediately post-operatively and the stoma/peristomal skin condition with

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each appliance change using a validated classification tool for monitoring complications (Level 5)
• Identification of risk factors for stomal and peristomal complications (Level 4)
• Review of medication profile to ensure that maximum absorption and effectiveness will be achieved in
relation to the type of ostomy (Level 5)
• Avoiding insertion of glycerine suppository into a colostomy to aid in evacuation (Level 1)
• Counselling by a registered dietician for those who are at risk for or who develop nutritional
complications (Level 2)
• Home care support for the client and family at discharge (Level 1)
• An individualized plan of care to meet the needs of the client and family (Level 5)
• Assessment and follow-up by an enterostomal therapy nurse (ETN) to decrease distress, promote
quality of life and prevent complications (Level 2)
• Education of client and family members to recognize complications affecting the stoma and periostomal
skin (Level 5)
• For select adult clients, implementation of colostomy irrigation for the management of descending or
sigmoid colostomies for select adult clients (Level 4)
• A systematic and client-centered ostomy education for all levels of health care providers, provided in
both academic and workplace settings (Level 5)
• Consultation with ETN in the development of ostomy educational programs (Level 5)

• A clinical practice guideline developed by the Wound, Ostomy, and Continence Nurses Society for the
management of fecal ostomy recommends the following:2

• Ostomy education that includes a preoperative and postoperative component provided by a specialized
nurse such as a wound, ostomy and continence nurse (Level 2)
• A stoma site marking performed preoperatively to reduce the incidence of complications and improve
self-care (Level 2)
• An ostomy pouching system that is comfortable, odor proof and protect the peristomal skin. Wear time
should be at least three days and not exceed seven days (Level 4)
• Early identification of stomal and peristomal problems with timely interventions (Level 4)

• A best practice guideline recommends the provision of a comprehensive discharge plan to a patient with
a new ostomy. This should include teaching basic skills (i.e. emptying and changing the pouching
system), providing information about ostomy management (e.g. diet/fluid guidelines, signs of potential
complications, factors to consider regarding medications and management of gas and odor), instructions
about how to order supplies, assistance with transitions of care, and providing information about
resources for support and assistance. Involvement of family members or caregiver should also be
encouraged whenever possible when planning for discharge.3 (Level 5)

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Characteristics of the Evidence
This summary is based on a structured search of the literature and selected evidence-based health care
databases. Evidence in this summary is from:

• A clinical practice guideline developed by the Registered Nurses’ Association of Ontario.1

• A clinical practice guideline developed by the Wound, Ostomy, and Continence Nurses (WOCN)
Society.2
• A best practice guideline developed by the WOCN Society’s Clinical Practice Ostomy Task Force.3

Best Practice Recommendations

• The preparation of a patient who may require a stoma should begin as soon as surgery is considered.
(Grade B)
• The assessment of individual patient’s needs and appropriate information on planned surgery, care and
living with a stoma is recommended before a planned surgery. (Grade B)
• Stomas require sufficient care and management to reduce complications. Nurses should play a major
role in assisting or performing stoma care techniques for patients with stomas. (Grade B)
• Each patient should be assessed for risk factors that may influence stomal and peritoneal complications
and the care strategy for the stoma informed by the assessment. (Grade B)
• Patients who need to have a stoma created should be educated about the stoma including caring for it
pre-operatively. (Grade B)
• The family of the patient with a stoma should be provided with information about the stoma and how it
needs to be managed. (Grade B)
• Religious and cultural beliefs must be taken into account when looking after patient with a stoma. (Grade
A)
• An early discharge plan with established goals for rehabilitation is recommended for patients with a
newly formed stoma. (Grade B)
• An assessment of the patient’s competence and skills regarding self-care of his/her stoma is
recommended before their discharge. (Grade B)

References
1. Registered Nurses’ Association of Ontario. Ostomy Care and Management. Toronto, Canada.
Registered Nurses’Association of Ontario; 2009.
2. Wound, Ostomy, and Continence Nurses Society (WOCN). Management of the patient with a fecal
ostomy: best practice guideline for clinicians. Mount Laurel (NJ): Wound, Ostomy, and Continence Nurses
Society (WOCN); 2010.
3. Prinz A, Colwell J, Cross H, Mantel J, Perkins J, Walker C. Discharge planning for a patient with a new
ostomy: best practice for clinicians. J Wound Ostomy Continence Nurs. 2015; 42(1): 79-82.

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The author declares no conflicts of interest in accordance with International Committee of Medical Journal Editors (ICMJE) standards.
How to cite: Yimei Li, MBBS, MMed, MPH. Evidence Summary. Stoma: Care and Assessment. The Joanna Briggs Institute EBP Database,
JBI@Ovid. 2018; JBI85.
For details on the method for development see Munn Z, Lockwood C, Moola S. The development and use of evidence summaries for point of care
information systems: A streamlined rapid review approach. Worldviews Evid Based Nurs. 2015;12(3):131-8.
Note: The information contained in this Evidence Summary must only be used by people who have the appropriate expertise in the field to
which the information relates. The applicability of any information must be established before relying on it. While care has been taken to
ensure that this Evidence Summary summarizes available research and expert consensus, any loss, damage, cost or expense or liability
suffered or incurred as a result of reliance on this information (whether arising in contract, negligence, or otherwise) is, to the extent
permitted by law, excluded.
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