P0935 A systematic review and quality assessment of clinical practice nursing guidelines for ostomy care

Abstract

Listen

Translate article

Abstract Background Patients living with stomas face numerous challenges following abdominal stoma surgery. Stoma nurse specialists play a crucial role in supporting these patients by utilizing evidence-based practices and specialist expertise. We evaluate nursing guidelines focused on the management of patients with ostomies, identify knowledge gaps, and support the development of evidence-based patient care pathways. Methods A comprehensive literature search was conducted across MEDLINE, Embase, and major nursing organization websites up to March 25 2024, to identify evidence-based practical guidelines developed specifically for nurses managing patients with abdominal stomas post-ostomy. Pre-specified inclusion (n=5) and exclusion (n=16) criteria were applied (Table 1). Two researchers independently screened references, extracted data, summarized the evidence, and assessed guideline quality using the AGREE II instrument. Results The database search yielded 97 references, with an additional 23 guidelines identified through major nursing organization websites. A total of 14 nursing guidelines met the inclusion criteria, originated from Australia, Canada, Italy, UK, USA, and three international groups. The guidelines varied in scope; offered recommendations across all stages of care, including preoperative, peri-operative, postoperative, and post-discharge phases. Key topics are presented in Table 2. Notably, no guideline statements specifically addressed patients with Crohn’s disease and permanent ostomies. Three guidelines did not specify whether a literature search and review were conducted. Five guidelines applied an evidence scale or numerical grading system, while only three used the GRADE approach. Most recommendations were based on a low level of evidence, often relying on retrospective or observational studies and expert opinion; two guidelines claimed their statements were consensus-based due to a lack of supporting evidence. In the AGREE II assessment, most guidelines were rated as moderate quality, with recommended modifications primarily in the rigor of development and applicability. Conclusion This quality assessment of clinical practice nursing guidelines for ostomy care highlights both strengths and weaknesses within current guidelines. Nursing guidelines offer extensive coverage of ostomy care topics and provide valuable first-line care experience and consensus statements, particularly for postoperative stoma and peristomal care. These insights are essential for non-nursing healthcare providers and contribute to the development of patient care pathways for individuals with Crohn’s disease and permanent ileostomies. However, the limited availability of high-quality evidence underscores the need for further research in ostomy care.