|Organisation sharing the GOP||
Related practices from PaSQ database
|Program on quality and safety
Quality improvement project
|1) Make the stoma marking a few days before the surgery, so that a suitable position for every patient can be obtained, keeping in mind their daily life.
2) Provide the patient, family and/or carer the knowledge and training required for the care of the stoma.
|Patients with bladder carcinoma tributary to a radical cistectomy with urinary diversion called Bricker.|
|When the surgeon programs the radical cistectomy with urinary diversion called Bricker, an appointment with the consulting room of urological nursing -stomatherapist is automatically set, around 10 days before the surgery.
During the first visit a Personalized Care Planning will be performed, including:
-Initial assessment following the 14 fundamental needs of Virginia Henderson.
-Transcript to NANDA language for the Nursing Diagnosis.
Sequence of appointments:
*First visit before the admission: marking of the stoma is performed, the urostomy bag is placed on the ideal position and the patient receives a Questionnaire about the stoma marking.
*Second visit: the patient delivers the completed questionnaire and they decide together with the nurse , the position of the stoma.
*Third visit: it takes place before the discharge from the hospital. The nurse makes notes of the final location of the stoma and she/he explains the care from it.
Monitorization on the 3, 6 and 12 months.
The number of appointments will be adjusted to the needs of each patient..
|Related with number of operations/year and nursing experience.
Institution activity 235 cistectomy type Bricker from 2010 to 2013 and with 25 years experience in urological nursing.
Progressive establishment, starting in 2010 with patients who have a difficult location of the stoma. This practice is formalized since april of 2013
|Implementation tools available|
|1) Personalized Care Planning
2) Questionnaire of the Stoma marking which is delivered to the patient. This questionnaire includes two parts: a) 13 qualitative questions and b) symbol of the location of the stoma.
3)Form of anthropomorphic information, which includes weight, size, body-mass index, abdominal perimeter and wrinkles during the bipedestation, prone and sit position.
4)Regulation Form of the late complications.
See attached files
|In our Institution, we only supposed, to formalize this practice:
-increase in 5 hours/week the schedule of the specialized nurse. Daily dedication of 35h/week.
-cost of the training: ‘Master in expert in Care Nursing. Global care of the patient with stoma’. European University of Madrid 250h (10ECT’s).
|Method used to measure the results|
|The methodology to measure the results in phase of test. The qualitative items of the questionnaire delivered to the patient will be analyzed, since they have been designed for a statistical analysis with dichotomous variables (see attached file).|
|The monitoring of 25% of the patients have been performed, who applied the BPI. They only contemplate two aspects: a)the performance of the questionnaire, which refilled the patient and b) the position of the stoma: coincidence between the recommended indication of the nurse and the surgeon.
Results of this monitoring:
a)compliance of the Questionnaire from the patient 66,2%
b)coincidence in the ubication of the stoma: coincidence yes 66.2%, coincidence no: 20%, not be clear 13.3%.
|Analysis of the results|
|Performance of the Questionnaire
There are not counted: the questionnaires with some items , which are not being completed, and the questionnaires which the patient didn’t want to fill in during the 2o visit with the nurse.
This preliminary test, which result is improvable, will help the nurse to strengthen during the visit this point: make aware the patients of the importance.b) Change of the location of the mark
A 20% of no coincidence isn’t a despicable result. It’s premature to extract conclusions. About the change of satisfaction of the patient in relation of the location of the stoma.
|Did you find implementation barriers?|
|Please describe implementation barriers|
|There is no specified text here|
|Describe the strategies used to overcome the barriers (If needed)|
|There is no specified text here|
|Other information about the GOP that you would like to add (Link or attached document)|
|Changes in the methodology of the BPI.
From the formalizing of this practice it has been quantified the number of patients, who had required the aid of a clinical psychologist, that’s the reason to include it during the practice.
The system of work consists in programming automatically one visit with the patient, in the moment that the surgeon plans this type of intervention.
During the first visit the psychologist will value the patient and in the second visit, which they realise the mark , location and explanation of the dispositive.
The nurse will follow the patient after the surgery. After the discharge from the hospital, the frequency of the visits will be adequate the needs of the patient. It will be started since April.Another anticipated change, is the care (from the nurse) to the main carer, by the reinforcement of training about: the stoma and the dispositive. Emotional support is do it by the psychologist. They don’t determine the date of starting.20140314020044634_877_GOP_Consulting room.zip