Stoma care and enhanced recovery

Abstract

Enhanced recovery programmes are now widely used to improve the experience of patients undergoing stoma-forming surgery. Such programmes utilise a number of evidence-based elements to improve patient outcomes, including a shorter preoperative starvation period, preoperative carbohydrate loading, early mobilisation, early resumption of oral intake, early removal of intravenous fluids and early urinary catheter removal. Enhanced recovery patients are less likely to have postoperative infections and are able to go home earlier—typically just four days after a colonic resection. While there are clear benefits to going home early, less time is available for stoma training. To ensure that patients are not compromised, adaptations of care need to be planned and undertaken. These may include preoperative training, daily or twice-daily teaching on stoma care, ward nurse training of patients and commencing training on the first postoperative day. Follow-up is also essential, to ensure that the patient is coping with their newly-formed stoma at home. This can be undertaken as a home visit, a telephone follow-up or in the clinic setting.