Implementing a Validated Peristomal Skin Assessment Instrument into Clinical Practice to Facilitate...
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Transcript of Implementing a Validated Peristomal Skin Assessment Instrument into Clinical Practice to Facilitate...
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 people
living with an ostomy depends
mainly on the integrity of their
peristomal skin.
Maintaining a healthy
peristomal skin is therefore,
the main objective of any
healthcare professional that
manages ostomates.
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
STOMATHERAPY IN ITALY: Panoramic
44,87%
21,35%
33,78%
Ostomy patients in Italy
Nord Italia
Centro Italia
Sud Italia
THE SACS STUDY: Review of the Literature
Peer-to-Peer discussion
Review of the
Literature
Peristomal Lesions
(Dermatologist)
Need for a shared and recognized
classification
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
According to my esperience, approximately 1/3 of Colostomates and 2/3 of Ileo-Urostomates suffer from at least one peristomal lesion.
THE SACS STUDY: Review of the Literature
33% 67%
Type of Ostomy
Colostomy Ileo-Urostomy
Incidence of complications of the stoma and peristomal skin among individuals with colostomy, ileostomy, and urostomy: a systematic review. Salvadalena G. Journal Wound Ostomy Continence Nurs. 2008 Nov-Dec;35(6):596-607; quiz 608-9.
1. Number of participants in each phase of the analysis.
2. Different length of the studies.
3. No definitions of skin disorders.
4. No description of the
assessment of the skin
lesions.
THE SACS STUDY: Review of the Literature
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
OBJECTIVE N.1: Assess and
classify peristomal skin disorders.
OBJECTIVE N.2: Evaluate the
correlation between blood
chemistry and severity of
peristomal lesions.
OBJECTIVE N.3: Diagnosis and
treatment of peristomal skin
disorders.
DEFINITION OF THE
PARAMETERS FOR
THE RESEARCH:
The Study group agreed
on not taking into
consideration:
- The etiology of the
peristomal skin
disorders
- the therapeutical
treatment
FUTURE STEPS
December 2003
2004
2005
February 2006
Beginning of
the SACS
Study
OSTOMY
CENTERS
• Rome
• Catania
• Messina
• Turin
OSTOMY
CENTERS
• Bozen
• Prato
• Empoli
CLASSIFICATION
OF THE
PERISTOMAL
SKIN DISORDERS
End of
the
SACS
Study
June/July
2006
Ostomy Patient
S.A.C.S.
Study
ENROLLMENT
Group 2
> 1 year
Group 1
< 1 year
Time frames
(0, 4, 12, 24 weeks)
ASSESSMENT
• General Evaluation
• Blood Chemistry
• Pictures
REGISTRATION
Data Analysis with SPSS
software
Consensus
Conference
Classification of Peristomal Skin Disorders
2* END POINT of the
SACS Study
THE SACS STUDY: Results
656 PATIENTS ENROLLED
• 380 (group 1 < 1 yr)
• 276 (group 2 > 1 yr))
THE SACS STUDY: Results
THE SACS STUDY: Definitions
PERISTOMAL AREA:
The term “peristomal” is meant to include the whole skin around the stoma (within 7,5 cm, which is the maximum size of the skin barriers available in the market), even if it is not directly linked with the stoma.
7,5 cm 7,5 cm
THE SACS STUDY: Definitions
THE PREDOMINANT SIGN:
It was decided that the classification should always refer to the most sever lesion first. Additional lesser lesions can also be classified as an option to conform to local practice.
In general, the classification should include only one “L” and one or more “T”.
L1
HYPEREMIC LESION Peristomal redness with intact skin.
SACS CLASSIFICATION
THE SACS STUDY: Classification
LESION (L)
L2
EROSIVE LESION Open lesion NOT extending into subcutaneous tissue; partial thickness skin loss.
SACS CLASSIFICATION
THE SACS STUDY: Classification
LESION (L)
L3
ULCERATIVE LESION Open lesion extending into subcutaneous tissue and below; full thickness skin loss.
SACS CLASSIFICATION
THE SACS STUDY: Classification
LESION (L)
L4
ULCERATIVE LESION Full thickness skin loss with non-viable, dead tissue (necrotic, fibrinous).
SACS CLASSIFICATION
THE SACS STUDY: Classification
LESION (L)
LX
PROLIFERATIVE LESION Abnormal growths present (i.e. hyperplasia, granulomas, neoplasms)
SACS CLASSIFICATION
THE SACS STUDY: Classification
LESION (L)
THE SACS STUDY: Topography
TOPOGRAPHY (T)
Perspective of the HCP
- I = Upper Left Quadrant
- II = Upper Right Quadrant
-III = Lower Right Quadrant
- IV = Lower Left Quadrant
- V = All the Quadrants
Patient standing in front of the HCP
The order of the quadrants around the stoma
starts in the Upper Left corner (TI) and ends in the
Lower Left corner (TIV) clockwise.
TI TII
TIII TIV
TI
TII TIII
TIV
TV TV
THE SACS STUDY: One Instrument, two approaches
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
Requests of further info about the study
Requests of partecipation in the study
Translation in many other languages
THE SACS STUDY: In Europe
• ET Centers involved
• Hospitals in Central & Northern Italy
• ConvaBase
• Brochure & Ruler
• Nursing Management of Peristomal Lesions
• Tissue Repair and Ostomy Training Sessions
• University Training Courses
Education & Training for Nurses
Insertion in Hospital Protocols
Tools to facilitate the use of the Classification
THE SACS STUDY: In Italy
THE SACS STUDY: San Giuseppe Hospital –
Empoli (Italy)
THE SACS STUDY: Useful Tools
BROCHURE
RULER
SOFTWARE
(CONVABASE)
BADGE
"Helm, full ahead," she orders. "Let's see what's 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 she
laughs, 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
• Laura Anselmi
• Stefano Gasperini
• Diego Mastronicola
GRAZIE per l’attenzione!