The Ostomy Skin Tool –2 .rész workshop

The Ostomy Skin Tool –2.rész workshop

The Ostomy Skin ToolWorkshop and case studiesESET TANULMÁNYOK Anna Monika Tomanek Clinical Advisor

   Meeting objectives CÉLKITŰZÉS Workshop 1 – simple caseEGYSZERŰ Workshop 2 - complex caseÖSSZETETT Using the Ostomy Skin Tool in practiceGYAKORLÁS

Workshops: 2 cases /2 ESET • Plenary: Introduction to the cases BEVEZETÉS • Workshop: MŰHELYMUNKA • Review case study with histories and photographs TÖRTÉNET+FOTÓ • Assess the case using the Ostomy Skin Tool- DIAGNÓZIS • Discuss with colleagues in your group - MEGBESZÉLÉS • Plenary: Voting and Discussion SZAVAZÁS+ VITA

Case 1 Case 1: Visit 1

Area score = ? TERÜLETI PONT Severity score = ? SÚLYOSSÁGI PONT Domain 1: Discolouration ELSZÍNEZŐDÉS

Area score TERÜLETI PONT= 1 Severity score SÚLYOSSÁGI PONT = ? Domain 1: Discolouration ELSZÍNEZŐDÉS

Area score = 1 TERÜLETI PONT Severity score = 2 SÚLYOSSÁGI PONT Domain 1: Discolouration ELSZÍNEZŐDÉS

Area score = ? TERÜLETI PONT Severity score = ? SÚLYOSSÁG Domain 2: Erosion FELMARÓDÁS

Area score = 1 Severity score = ? Domain 2: Erosion

Area score = 1 Severity score = 2 Domain 2: Erosion

Area score = ? TERÜLETI PONT Severity score = ? SÚLYOSSÁG Domain 3: Tissue overgrowth KINÖVÉSEK

Area score = 0 Severity score = ? Domain 3: Tissue overgrowth

Area score = 0 Severity score = 0 Domain 3: Tissue overgrowth

Summary of case 1: Total DET score PONT ÖSSZESÍTÉS D 1 2 3 E 1 2 3 T 0 0 0 DET score 6 TOTAL = 6

Case 1: Using the DET score Case 2: Visit 1

Case 2: Visit 12.ESET 1. VIZIT • Background information: HÁTTÉR INFO • Sex: Male FÉRFI • Age: 67 years old KORA 67 ÉV • Reason for stoma creation: Diverticulitis • Type of stoma: Colostomy • Average adhesive wear time: 2 days ESZKÖZT CSERÉL 2 NAPONTA

Area score = ? TERÜLETI PONT Severity score = ? SÚLYOSSÁG Domain 1: Discolouration ELSZÍNEZŐDÉS Visit 1

Area score = 2 Severity score = ? Domain 1: Discolouration Visit 1

Area score = 2 Severity score = 1 Domain 1: Discolouration Visit 1

Area score = ? TERÜLETI PONT Severity score = ? SÚLYOSSÁG Domain 2: Erosion FELMARÓDÁS Visit 1

Area score = 2 Severity score = ? Domain 2: Erosion Visit 1

Area score = 2 Severity score = 1 Domain 2: Erosion Visit 1

Area score = ? TERÜLETI PONT Severity score = ? SÚLYOSSÁG Domain 3: Tissue overgrowth KINÖVÉSEK Visit 1

Area score = 1 Severity score = ? Domain 3: Tissue overgrowth Visit 1

Area score = 1 Severity score = 2 Domain 3: Tissue overgrowth Visit 1

Summary of case 1 at Visit 1: Total DET score ÖSSZESÍTŐ D 2 1 3 E 2 1 3 T 1 2 3 DET score 9 TOTAL = 9

Case2: Visit 2

Domain 1: Discolouration ELSZÍNEZŐDÉS • TERÜLETE • Area score = ? • Severity score = ? SÚLYOSSÁGA Visit 2

Domain 1: Discolouration • Area score = 1 • Severity score = ? Visit 2

Domain 1: Discolouration • Area score = 1 • Severity score = 1 Visit 2

Area score = ? TERÜLETI PONT Severity score = ? SÚLYOSSÁG Domain 2: Erosion FELMARÓDÁS Visit 2

Area score = 1 Severity score = ? Domain 2: Erosion Visit 2

Area score = 1 Severity score = 1 Domain 2: Erosion Visit 2

Area score = ? TERÜLETI PONT Severity score = ? SÚLYOSSÁG Domain 3: Tissue overgrowth KINÖVÉSEK Visit 2

Area score = 1 Severity score = ? Domain 3: Tissue overgrowth Visit 2

Area score = 1 Severity score = 1 Domain 3: Tissue overgrowth Visit 2

Summary of case 2 at Visit 2: 2.ESET 2. VIZITTotal DET score ÖSSESÍTŐ D 1 1 2 E 1 1 2 T 1 1 2 DET score 6 TOTAL = 6

TOTAL = 6 TOTAL = 9 Summary of case 2ÖSSZEFOGLALÁS 2. ESET Visit 1 Visit 2

The Ostomy Skin ToolUsing the Ostomy Skin Tool in practice – A GYAKORLATBAN

Patient and case study ESETTANULMÁNY • 69-year-old woman 69 ÉVES NŐBETEG • Emergency surgery for a bowel infection and had an ileostomy SÜRGŐSSÉGI MŰTÉT, BÉLFERTŐZÉS, ILEOSTOMA Case history • Day 14 after surgery, ostomy appliance found leaking and causing patient distress 14 MÚLVA SZIVÁRGÁS AZ ESZKÖZNÉL… • Using the Ostomy Skin Tool, a DET score of 4 was calculated PONTSZÁMA DET 4

Assessment 1 DET score1.VIZSGÁLAT PONTSZÁMA

Visit 2 • At the return visit 13 days later, the DET score was 2 • 13 NAP MÚLVA PONTSZÁMA DET 2 • The appliance was adhering; the patient was not experiencing peristomal skin discomfort and she was much happier • JÓL TAPAD AZ ESZKÖZ • By using the DET score, whichever nurse saw the patient on subsequent visits had a clear and uniform way to evaluate the peristomal skin and decide if it was improving or deteriorating, providing seamless patient care • BÁRKI LÁTTA EL, AZONOS MÓDON ÉRTÉKELTE A JAVULÁST

Assessment 2 DET score2.VIZSGÁLAT DET PONTOK

The patient: Mr M 69-year-old man with Crohn’s disease 69 ÉVES FFI CHRON B. Abdominal perineal resection with ileostomy in 1998 No extraintestinal manifestations Case history Recent onset of peristomal ulcerationsSTOMA KÖRÜL FEKÉLY Two visits to emergency department 2 SÜRGŐSSÉGI VIZIT Presented to the clinic in “excruciating” pain FÁJDALMA 10-ES Pain rating 10 out of 10 Patient and case history ESET TANULMÁNY

Visit 1 Assessment 1 DET score Baseline ALAPADAT Pyoderma gangrenosum (PPG) Example of PPG

Visits 2 and 3 Assessment 3 DET score Week 4. HÉT Assessment 2 DET score Week 2. HÉT Pain rating 6 out of 10 FÁJDALOM INDEX 6 Pain rating 8 out of 10 FÁJDALOM INDEX 8

Justifying Mr M’s care BIZONYÍTÁS • Administrators were concerned about the time and resources used IDŐ, KÖLTSÉG • Claimed Mr M was “clearly no longer a hospital patient” • Ostomy care nurse reviewed the case with the administrators • Lack of community resourcesand emergency care inappropriateFORRÁSHIÁNY • Used DET scores to show severity of disorder and effect of appropriate treatments and expert management DOKUMENTÁLT KEZELÉSI EREDMÉNYEK

It is not just what you know that creates Best Practice… NEM AZ JÓ PÉLDA, AMIT TUDSZ, CSAK AZ, AMIT MEGTESZEL!!! It is what you do that creates Best Practice!!! REMEMBER: EMLÉKEZZ: Slide Courtesy Dr. Sibbald

Thank youKÖSZÖNÖM Anna Monika Tomanek Clinical Advisor

The Ostomy Skin Tool –2 .rész workshop