Management of stoma among colorectal cancer patients in a surgical ward: a best practice implementation project

Background The incidence and mortality of colorectal cancer are higher in China than those of global average levels. Approximately one quarter of patients undergoing surgery for colorectal cancer will require a temporary or permanent stoma. The perioperative care of stoma can reduce discomfort and maximize the patient's self-care competence. Objectives The aim of this project was to implement the best available evidence of stoma management into practice and to improve the self-care of patients with a stoma. Methods We conducted an evidence utilization project, including a baseline audit, feedback and a follow-up cycle. Six criteria were audited in the colorectal surgery ward of Fudan University, Shanghai Cancer Center. Twenty-four nurses as well as 61 patients and their caregivers were involved. The Joanna Briggs Institute's Practical Application of Clinical Evidence System (PACES) program and its Getting Research Into Practice (GRIP) module were used to examine compliance with the criteria derived from best practice before and after the implementation of best practice. Results The compliance rates of daily stoma assessment, stoma care education, appliance selection, self-care ability assessment and discharge planning achieved 100%. However, the lowest compliance rate was for preoperative education (58%). There were improvements in compliance rates for five criteria from 21% to 100%, except for stoma-care education which was already 100% implemented. Conclusions The project has made a significant improvement in establishing evidence-based practice for stoma management in the colorectal surgery ward. Further challenges will be in developing strategies to sustain best practice.