The Journal of Stomal Therapy Australia

Transcription

The Journal of
Stomal Therapy Australia
ISSN 1030 5823
Print Post Approved PP 642521/00041
VOLUME 30
NUMBER 2
june 2 0 1 0
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The Journal of
Stomal Therapy Australia
Volume 30 Number 2 – June 2010
ISSN 1030-5823
Copyright © 2009 by the
Australian Association of Stomal Therapy Nurses Inc. ABN 16072891322
AASTN Code of Ethics
• The stomal therapy nurse must at all times maintain the
highest standards of nursing care and professional conduct.
• The stomal therapy nurse will provide needed services to
persons irrespective of their race, colour, creed, sex, sexual
preference, age and political or social status.
• The stomal therapy nurse must respect the beliefs, values
and customs of the individual and maintain his/her right to
privacy by maintaining confidentiality, sharing with others
only information relevant to that person’s care.
• The stomal therapy nurse will not participate in unethical
practice.
• The stomal therapy nurse must maintain competency by
keeping abreast of new developments in the theory and
practice of stoma care and related fields.
• The stomal therapy nurse will participate actively in
professional, inter-professional and community endeavours in
order to meet the highest professional standards.
• No full member shall be in the employ of a company or self
employed in the manufacture or sale of products, prostheses
or pharmaceuticals where it could be perceived that the use
or selling of products prostheses or pharmaceuticals could
disadvantage or contradict the personal preference of clients
or be construed to result in unethical conflict of interest.
Published four times a year by
Contents
President’s report
3
Editorial
4
Articles
Medication awareness: loperamide
hydrocholoride for the treatment of a
high-output ileostomy
8
Management of chronic radiation proctitis 10
Fast Track Surgery – Should all
components of fast track surgery be
introduced into the Australian hospital
system or certain aspects?
15
Case study using Adapt Rings to prevent
appliance leakage
20
Report for Executive Committee:
Australian Association of Stomal Therapy
Nurses (AASTN)
22
AASTN website coordinator report
30
ACSA report
31
WCET report
32
State reports
33
a division of Cambridge Media
10 Walters Drive, Osborne Park WA 6017
Web www.cambridgemedia.com.au
Copy Editor Rachel Hoare
Graphic Designer Sarah Horton
Advertising enquiries to
Simon Henriques, Cambridge Publishing
Tel (08) 6314 5222 Fax (08) 6312 5299
Email [email protected]
Disclaimer The opinions expressed in the Journal of Stomal Therapy Australia
are those of the authors and not necessarily those of the Australian Association of
Stomal Therapy Nurses Inc., the editor or the editorial board.
Editorial Board
Lorrie Gray RN MSc(Ed) BSoc SC STN
WA Branch STNEP Coordinator
Keryln Carville RN PhD STN (Cred)
Silver Chain Nursing Association
Julia Kittscha RN STN BHSc
Wollongong Hospital, NSW
Patricia Blackley RN Grad DipEd STN
Life Member AASTN and WCET
Journal of Stomal Therapy Australia – Volume 30 Number 2
1
Directory
Executive committee
Karen McNamara
Acute Home Care Service
Joondalup Health Campus,
Shenton Ave, Joondalup WA 6027
Tel (08) 94009297 (w)
Mob 0431 603 230
Public Officer
Carol Stott
Stomal Therapy Department
Dickinson 2 North, Prince of Wales Hospital
Barker St, Randwick NSW 2031
Tel (02) 9382 3869
Sharmaine Peterson
St Andrew’s Hospital
350 South Terrace, Adelaide SA 5000
Tel (08) 8408 2164 (w)
V/President
Helma Riddell
G.S.A.H.S, PO Box 159
Wagga Wagga NSW 2650
Tel (02) 6938 6487
Mobile 0427 460 024
Treasurer
Vanessa Rhodes
Royal Hobart Hospital
48 Liverpool Street, Hobart, Tas 7000
Tel (03) 6222 8283
Mobile 0409 807 827
SPAP LiaisonDiana Hayes
CNC/Stomal Therapy, Western Hospital
Gordon Street, Footscray VIC 3011
Tel: (03) 8345 6553
Mobile: 0428 441 793
Secretary
Margaret Fraser
3/70-74 Brunswick Road, Brunswick, VIC 3056
Tel (03) 03 9388 0791
Mob 0410 417 287
AASTN state representatives
MembershipRobyn Simcock
Coordinator
PO Box 153, Floreat WA 6014
Mob 0417 627 970
EditorTheresa Winston
Fraser Coast Health Service, Hervey Bay Hospital,
PO Box 592, Hervey Bay QLD 4655
Tel 0438 738 074 (w)
2
Website
Coordinator
President
Committee
Sue Delanty
Launceston General Hospital
Charles Street, Launceston TAS 7250
Tel (03) 6348 7832 (w)
Mob 0417 395 536
Debra D’Silva
6 Sundercombe Street, Osborne Park, WA 6017
Tel (08) 9242 0242
Mobile 0410 222 048
Genevieve Cahir
Northern Hospital, 185 Cooper Street
Epping, Vic. 3076
Tel (03) 8405 8597
Mobile 0417 385 533
Education
Subcommittee
Fiona Bolton
64 Carlisle Street, Ethelton SA 5015
Mob 0418 266 680
WCET ID
Brenda Sando
The Wesley Hospital
Chasley Street, Auchenflower QLD 4066
Tel (07) 3232 7989 (w)
CPD &
Credentialling
Officer
Sue Delanty
Launceston General Hospital
Charles Street, Launceston TAS 7250
ACT
Kellie Burke
CNC Stomal Therapy
The Canberra Hospital, PO Box 11, Woden ACT 2606
Tel (02) 6244 2222 page 50959
Fax (02) 6205 2829
NSW
Jenny Rex
CNC
Royal Prince Alfred Hospital
Missenden Road, Camperdown NSW 2050
Tel (02) 9515 8990
NT
Jennifer Byrnes
Royal Darwin Hospital, Rocklands Drive, Tiwi NT 0810
Tel (08) 8922 8888
QLD
Helleen Purdy
St Andres’s War Memorial Hospital
47 Wickham Terrace, Brisbane QLD 4001
Tel (07) 3834 4589
Fax (07) 3834 4373
SALynda Staruchowicz
Stomal Therapy Department,
Royal Adelaide Hospital
North Terrace, Adelaide SA 5000
Tel (08) 8222 4000 pager 1224
Tel (08) 8222 4416 for answering machine
TASTracey Beattie
North West Regional Hospital
Brickport Rd, Burnie TAS 7320
Tel (03) 6430 6588
Mob 0408 317 411
VIC
Patricia McKenzie
5 Royal Place, South Morang VIC 3752
Tel 1300 33 44 55
Mob 0406 534 850
WALeigh Davies
6 Sundercombe Street
Osborne Park WA 6017
Tel (08) 9242 0242 (w)
Mob 0410 222 386
President’s report
The AGM 2010
Sharmaine Peterson
Greetings to all. I hope you had a happy, safe Easter with time to
spend with your family and friends.
so if you have a case study or poster idea, please submit it for
consideration.
The past year as President has been a vast learning experience
and I have met many interesting people at the various meetings
I have attended throughout this period.
Having attended the Education Subcommittee meetings, I have
realised how much work is involved. This is a group dedicated
to improving the standards of knowledge and qualifications of
their colleagues. Not only do they attend a twice-yearly meeting,
but spend many hours developing the credentialing exam,
formulating and updating patient handouts and developing
standards of practice. A considerable amount is done in their
own time. In South Australia, Merle Boeree coordinates a stomal
therapy course, as does Lorrie Gray in Western Australia.
This year’s Annual General Meeting was originally going
to be coordinated from Adelaide; however, due to the car
racing, Womadelaide and the Fringe, the venue was changed
to Geelong. I would like to thank Margaret Fraser (Executive
Committee Secretary) for acting as chauffeur to Sarah AxmanFriend (retiring Treasurer), Vanessa Rhodes (incoming Treasurer)
and myself. She kindly drove from one side of Melbourne to the
other to pick us up and drove us to Geelong. It was a warm
sunny day and we enjoyed an early lunch at a quiet beachside
restaurant before attending the AGM. Many states held an
education/study day to coincide with the AGM Hopefully you
will read about them in this journal.
The Victorian Conference Committee is progressing with their
plans for the joint conference with the Tripartite group. It is to
be held in Cairns on 3–7 July 2011. They have called for abstracts
As stated at the AGM, Karen McNamara (Website Coordinator),
with Phil Morton’s assistance, is in the process of organising a
members’ lounge. More information on this will be forthcoming
in the next few weeks.
I would like to welcome the new members to the Executive and
hope they enjoy their time with us. They are: Helma Riddell –
Vice-president; Vanessa Rhodes – Treasurer; Deborah D’Silva
and Genevieve Cahir – Committee members.
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3
Editorial
Theresa Winston
It’s hard to believe that by the time you are reading this journal,
we will be nearly halfway through 2010. Where does time go? I
know there are quite a few stomal therapists who’ll be heading
off to Phoenix, Arizona for the joint WOCN/WCET conference;
I hope you have a great time and look forward to hearing about
your experiences.
At their education day in March, the Queensland branch of the
AASTN invited me to give a presentation on how to write a
journal article. By having an article published, other people are
able to learn through your experiences and this may instigate
changes to their work practices or give them ideas on how to
manage difficult stomas or wounds. It is also a great way to earn
extra points for your PD portfolio, which now, with national
registration, will be even more important.
It can be quite daunting to submit a journal article, so I’ve
included here some of the tips from my presentation.
Document layout and format
It helps to set up your page correctly from the start. Use double
line spacing, 2.5cm margins on either side of the page, and any
graphics or photographs should be provided in .jpeg format.
Article structure
Your article should include a title, abstract, introduction, body
and conclusion. The title needs to be informative and specific.
The abstract should be a succinct 150–200 word summary of the
contents of the paper and should encapsulate the major ideas,
conclusions and recommendations. An introduction identifies
the purpose of the article and introduces the main message. The
body of the article develops the main message, explains and
gives details and examples. The conclusion is a summary of the
report and, if appropriate, an interpretation of the results.
Referencing
Referencing is an important area and acknowledges the work,
research and ideas of others. It also enables readers to find an
article or paper that may have been referred to. There are several
different referencing systems and the JSTA uses the Vancouver
system. This system allocates a number to each reference as it is
cited. The same number is reused each time the reference is cited
in the text, regardless of its previous position. An example of a
reference using this system:
Peristomal skin disorders are often self-reported by over 80
per cent of patients with ileostomies 1 with irritation from
stoma effluent being a common cause 2.
This compares to the American Psychological Association (APA)
referencing style:
4
Peristomal skin disorders are often self-reported by 80 per cent
of patients with ileostomies (Martin, J., Hughes, T. & Stone,
N. 2005) with irritation from stoma effluent being a common
cause (Black 2000).
You’ll notice the Vancouver referencing system makes the article
read more clearly.
To add reference number/s to an article:
•Format.
•Font.
•Click on superscript.
•OK.
•Add number/s.
•Go back and uncheck superscript. (To save time you can
add superscript to your toolbar.)
The references should then be listed at the end of the text in
numerical order:
References:
1.Martin J, Hughes T & Stone N. Peristomal allergic contact
dermatitis – case report and review of the literature.
Contact Dermatitis, 2005; 52:273–275.
2.Black P. (2000). Practical stoma care. Nursing Standard
2000; 14(41):47–53.
If using material from another article, make sure you have
referenced it correctly. If reproducing an article, get permission
from the publisher. Make sure patients cannot be identified and
state how consent was obtained.
Two easy to follow articles on the Vancouver referencing system,
including how to reference websites, can be found at:
http://library.curtin.edu.au/local/docs/referencing/
vancouver.pdf
http://www.library.uq.edu.au/training/citation/vancouv.pdf
Writing simply and clearly
Easy to read articles help engage the reader and ensure messages
are understood correctly. Good grammar and sentence structure
can help with this. It may have been a long time since some of
us had lessons in sentence structure and grammar, so here are a
few tips:
Keep sentences direct, clear and concise. Expletive constructions
such as ‘There are’ or ‘It is’ take the place of the subject of a
sentence but may be unnecessary.
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Example:
7 There is a need for organisational writers to write readerfriendly documents.
3Organisational writers need to write reader-friendly
documents.
Try to avoid sentences that the reader needs to reread because
they are long and rambling. Break the information up into
shorter sentences.
Example:
7 The members present were from all over the state reflecting
the wide interest in the Association and it is to be hoped
that this interest will continue with a strong turnout for the
Annual General Meeting.
Colorectal Surgical Society of Australia
and New Zealand (CSSANZ)
Scholarship for Stomal Therapy Nurses
Purpose
To foster and further develop the relationship
between the Australian Association of Stomal
Therapy Nurses Inc. (AASTN Inc.) and CSSANZ,
the CSSANZ will present a scholarship for
a novice stomal therapy nurse (stomal therapy
nursing education programme completed within
the previous 3 years) to attend their annual Spring
Meeting. This is an annual award and will be presented at the
AASTN Inc. Annual General Meeting.
Award value
3The members present were from all over the state. We hope
that this wide interest in the Association will continue with
a strong turnout for the Annual General Meeting
This scholarship will cover registration to the annual CSSANZ Spring
Meeting, economy class airfare and $500 towards accommodation.
Don’t forget to include punctuation. Missing punctuation
can mean the reader has to reread and supply the missing
punctuation for the sentence to make sense.
7 The final figures were in the chair person was re-elected
Applicants must:
• Be a full member of the AASTN Inc.
• Be currently registered in the state where they are working and
utilising their stomal therapy nursing skills.
• Have completed an AASTN Inc. recognised stomal therapy
nursing education programme within the previous 3 years.
• Be able to attend the Spring Meeting in or outside Australia.
3The final figures were in. The chairperson was re-elected.
Process
Example:
OR
3The final figures were in; the chairperson was re-elected
Check your modifiers! A modifier is a word, phrase or clause
used to describe, limit, or give more detail about another part
of the sentence. An inappropriately placed modifier can create
ambiguity in meaning.
Example:
7 Lying on top of the intestine, you will see a small fistula.
It is the fistula, not you, that is lying on top of the intestine!
The modifying phrase needs to be moved close to the word it
modifies.
3You will see a small fistula lying on top of the intestine.
Feedback
Lastly, don’t be too shy to have your draft article critiqued and
edited. It will help you to have an article published that is of a
high standard. All feedback is useful, even if it just encourages
you to double-check something. Colleagues, family and/or
friends are probably more willing than you think, and are often a
great source of encouragement. My daughter checks my articles
and really enjoys reading and learning about the work we do.
I hope these tips encourage and help you to get started to write
a journal article. As always, I look forward to receiving your
articles and learning from your experiences.
Bibliography:
Petelin R & Durham M. The Professional Writing Guide. Sydney,
Woodslane Pty Ltd, 1998.
6
Eligibility Criteria
Submit an article suitable for publication in The Journal of Stomal
Therapy Australia (JSTA). The article may be in the form of, but not
limited to:
• A clinical case study.
• Research project.
• Book review not previously published in JSTA.
• Educational poster or teaching tool.
• Professional issue pertinent to either speciality.
The article, plus a completed official application form with a copy
of current nursing registration, must reach the national executive
secretary by 15 May in the relevant year. Contact details for the
secretary can be found in the current JSTA. Application forms are
available from the AASTN Inc. executive secretary and AASTN Inc.
website www.stomaltherapy.com
All applications will be reviewed by the judging panel. A decision
will be available and all applicants notified within 6 weeks. The
judging panel will consist of:
• The Editor, JSTA (or delegate).
• Committee member of the AASTN Inc Education and
Professional Development Subcommittee.
• Nominated member of the CSSANZ.
Late applications will not be considered. The scholarship award is
not transferable.
Selection Criteria
The decision of the judges is final and based on the following criteria:
• Presentation.
• Originality.
• Appropriateness to stomal therapy nursing and colorectal
surgery.
• Demonstrated integration of theory and practice.
• Suitability for publication following the JSTA Guidelines for
Authors found in the current JSTA.
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O259.
Medication awareness: loperamide hydrocholoride
for the treatment of a high-output ileostomy
Theresa Winston, Nurse Practitioner Wound Management/Stomal Therapy,
Sunshine Coast/Wide Bay Health Service, Hervey Bay, Queensland.
Introduction
It is important for stomal therapy nurses to understand the
therapeutic uses of medicines which their ostomates may be
prescribed: the normal dosage, side effects, precautions and
contraindications. The treatment of an ostomate with a highoutput ileostomy includes correction of electrolyte disturbance
and fluid balance, treatment of any underlying identifiable
cause plus pharmacological reduction of ileostomy output 1.
This article reviews the pharmacodynamics (effects of drugs on
the body) and pharmacokinetics (what the body does to a drug)
of loperamide which is often prescribed to reduce ileostomy
output. The article gives the results of findings from literature
review, on the use of loperamide for the management of highoutput ileostomies.
effects on the central nervous system are probably due to a slow
absorption rate, poor overall biodisposability and first-pass
metabolism 10. Loperamide undergoes significant enterohepatic
cycling.
Distribution – Eighty-five per cent of distribution takes place
in the gastrointestinal tract, 5% in the liver, 0.04 to 0.2% in the
tissues 12. Although loperamide does not cross the blood–brain
barrier it is transported back from the central nervous system by
a P-glycoprotein pump 10.
Review of loperamide for the treatment of
high-output ileostomy
Metabolism – Loperamide undergoes significant first-pass
biotransformation 12. First-pass metabolism occurs when drugs
are extracted so effectively by the liver or gut wall that only a
relatively small proportion of the drug will reach the target site
of action 5,7. Loperamide is extensively metabolised in the liver,
mainly by the cytochrome P450 (CYP 450) drug metabolising
enzymes 4.
Loperamide hydrocholoride is classified under alimentary tract
and metabolism as an antidiarrhoeal 2. Brand names include
Gastro-Stop™, manufactured by Aspen Pharmacare Australia Pty
Ltd, available in 2mg capsules and Imodium™, manufactured by
Janssen Cilag Pty Ltd. It is available in 2mg tablets and in a
chewable form 2,3.
Excretion – Renal excretion 12, the kidneys being a major site
for elimination of drugs from the body 5, with 24–40% of the
drug excreted unchanged in faeces 12. Elimination half-life is the
period of time required for the plasma concentration to decrease
to 50% of its original value 5. For loperamide this is between 9.1
and 14.4 hours 12.
The recommended dosage for adults with chronic diarrhoea or
intestinal stoma should be adjusted according to response, with
maintenance dose 4–8mg daily in 1–3 doses, with a maximum
dose of 16mg daily 3,4. The onset of action is within 1–3 hours 5.
Precautions: Patients with diarrhoea may have fluid and
electrolyte depletion and appropriate fluid and electrolyte
replacements need to be administered 15. Patients with an
impaired hepatic function should be monitored for signs of
central nervous system toxicity, which could be due to a
reduction in first-pass metabolism 15.
Loperamide is a P-glycoprotein substrate 6. P-glycoprotein has
an important role in the absorption, distribution and elimination
of many drugs and is present in the gastrointestinal tract 7.
Loperamide is mainly a peripheral acting μ-opiate receptor
agonist, which has a high affinity for μ-receptors 8. An agonist
is a drug that binds to a receptor and produces a maximum
response 9 and affinity means the tendency to bind to receptors 7.
Loperamide acts on μ-opioid receptors located on myenteric
nerves 10 in the intestinal mucosa 11. It is highly lipophilic and
undergoes slow dissolution 10.
Drug concentration levels
Time to peak concentration for oral capsules is five hours .
12
Absorption, Distribution, Metabolism and Excretion
Absorption is the passage of a drug from its site of administration
into the plasma 7. The absorbed drug is almost entirely bound
to the longitudinal, smooth-muscle layer of the intestinal wall13.
Loperamide is chemically related to pethidine 5 but it does not
cross the blood–brain barrier 13,14 and, therefore, has no analgesic
activity 7. Loperamide should still be used in caution even
though its side effects are less than other opioids 14. The low
8
Contraindications include:
- Abdominal pain in the absence of diarrhoea.
- Bacterial enterocolitis, caused by invasive organisms
including salmonella and campylobacter.
- Dysentery, acute.
- Hypersensitivity to loperamide or to any of the excipients
(inactive additives) 12.
Considerable loss of quality of life can occur as a result of highoutput ileostomies 16. In a search using Medline, including the
words loperamide and high-output ileostomy, very few clinical
papers were found dated within the last 10 years. This was
supported by a paper by DuPont and Sellin 16, who suggest that
treatment of patients with high-output ileostomies is often based
on observation or experiment as there are very few well-designed
therapeutic trials. King, Norton and Hill 17, conducted a doubleblind crossover study of patients with loose output from their
ileostomies that compared the use of loperamide hydrocholoride
4mg three times a day (t.d.s) with codeine phosphate, 60mg
t.d.s. 17 and concluded that loperamide hydrochloride was more
effective, with fewer side effects and a reduction in daily losses
of sodium and potassium. Wille-Jorgensen, Gudmand-Hoyer,
Skovbjerg and Andersen 18, compared the use of loperamide
and diphenoxylate on 27 patients, in a randomised, fixed
sample size, three-period crossover trial. Wille-Jorgensen et
al. 18 found that there was no significant difference found
between the two drugs used for treating diarrhoea on patients
with a jejuno-ileostomy. Tytgat, Huibregtse and Meuwissen 19
conducted a double-blind, placebo-controlled crossover study
on 20 ileostomy patients between the ages of 25 and 73 years.
Tytgat et al. 19 found that by using loperamide, the ileostomy
output decreased by 22%, compared to the drug-free phase
(p<0.001). Tytgat et al. 19 also found that patients experienced
an increased urinary production and an improvement in their
ileostomy care during their treatment with loperamide. Only
one paper was found which stated that loperamide had failed
to reduce stool output in one patient following a colectomy and
ileostomy, and successful reduction of output was gained by the
use of clonidine and somatostatin 20.
Loperamide is recommended for use in patients with a highoutput ileostomy in MIMS Annual 15 and AMH 3. Although other
papers do not mention having conducted trials, there are many
articles which suggest Loperamide has been established as being
useful to decrease stoma output 13,21-24.
From the evidence available, loperamide is effective in reducing
high-output ileostomy. Loperamide 4mg should be taken 30
minutes before food. This will hasten the absorption of the
medication before intestinal motility is initiated by the ingestion
of food 22. An ostomate with a high-output ileostomy should
be monitored for 48 hours and, if improvement with the use of
loperamide is not seen, administration should be discontinued
and the patient reviewed 15.
Conclusion
Lack of knowledge about medication therapy, incorrect use
of medication or noncompliance can cause a deterioration in
the ostomate’s health and possible readmission to hospital 25.
By having an understanding of the pharmacodynamics and
pharmacokinetics of medications, the stomal therapy nurse is
in a better position to communicate with the ostomate to ensure
safe and effective medication management.
References
1. Williams R, Hemingway D & Miller A. Enteral Clostridium difficile,
an emerging cause for high-output ileostomy. Journal of Clinical
Pathology 2009; 62(10):951–953
2. Australian Government – Department of Health and Ageing.
Pharmaceutical Benefits Schedule: Loperamide Hydrochloride.
Retrieved from: http://pbs.gov.au/html/healthpro/search/
results?term=LOPERAMIDE%20HYD Accessed 28 March 2007.
7. Rang HP, Dale MM, Ritter JM & Flower RJ. Rang and Dale’s
Pharmacology. 6th edn. New York, Churchill Livingstone Elsevier,
2007.
8. Otto B, Riepl R, Otto C, Klose J, Enck P & Klosterhalfen S. μ-Opiate
receptor agonists – a new pharmacological approach to prevent
motion sickness? British Journal of Clinical Pharmacology 2005;
61(1):27–30.
9. Birkett D. Pharmacokinetics made easy 10 Pharmacodynamics –
the concentration–effect relationship. Australian Prescriber 1995;
18(4):102–104.
10. Mazzoni O, Mazella di bosco A, Grieco P, Novellino E, Bertamino
A, Borrelli F et al. Synthesis and Pharmacological Activity of
2-(substituted)-3{2-[(4-phenyl-4-cyano)piperidino]ethyl}-1,3thiazolidin-4-ones. Chemical Biology and Drug Design 2006; 67:432–
436.
11. Ragnarsson G & Bodemar G. Letters to the Editor: Treatment of
irritable bowel syndrome with loperamide oxide. An open study to
determine optimal dosage. Journal of internal Medicine 2000; 248:
165–169.
12. Micromedex. Drugdex evaluations, Loperamide. Retrieved from:
http://micromedexudc.hcn.net.au/hcs/librarian/ND_PR/Main/
SBK/4/PFPUI/3Y3ZKE Accessed 29 March 2007.
13. Cohen LD & Levitt MD. A comparison of the effect of loperamide
in oral or suppository form vs placebo in patients with ileoanal
pouches. Colorectal Disease 2001; 3:95–99.
14. Hadley S & Gaarder S. Treatment of Irritable Bowel Syndrome.
American Family Physician 2005; 72(12):2501–2506.
15. MIMS Australia. MIMS Annual. 13th edn. Hong Kong, C&C Offset
Printing Co Ltd, 2006.
16. DuPont A & Sellin J. Ileostomy dirrhoea. Current Treatment Options
in Gastroenterology 2006; 9(1):39–48).
17. King R, Norton T & Hill G. (1982). A double-blind crossover study
of the effect of loperamide hydrochloride and codeine phosphate
on ileostomy output. The Australian and New Zealand Journal of
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18. Wille-Jorgensen P, Gudmand-Hoyer E, Skovbjerg H & Andersen
B. Diarrhoea following jejuno-ileostomy for morbid obesity. A
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Chirurgica Scandinavica 1982; 148(2):157–158. Retrieved from:
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delivery?vid=8&hid=14&sid Accessed 26 April 2007.
19. Tytgat G, Huibregtse K & Meuwissen G. Loperamide in chronic
diarrhea and after ileostomy: a placebo-controlled double-blind crossover study. Archivum Chirurgicum Neerlandicum 1976; 28(1):13-20.
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au/ehost/delivery?vid=8&hid=112&si Accessed 26 April 2007.
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April 2007.
21. Lyon C, Smith A, Griffiths C & Beck M. The spectrum of skin disorders
in abdominal stoma patients. British Association of Dermatologists
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3. Australian Medicines Handbook. Adelaide, Australian Medicines
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22. Cottam J. Management of high output ileostomy following rectal
resection. Gastrointestinal Nursing 2003; 1(7):19–23.
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with co-trimoxazole. British Journal of Clinical Pharmacology 1996;
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9
Management of chronic radiation proctitis
Kara Torney
Introduction
During my continence placement, I was fortunate to be involved
in the care of Sam*. Due to the chronic nature of Sam’s
history and his frequent admissions to the acute surgical
ward, combined with his reviews from the continence team,
a professional bond had been established between Sam and
myself. Upon commencement of this case study, I thought his
history was relevant and interesting for the development of
my case study. I asked Sam for permission to have access to
his medical records. Along with being actively involved in his
nursing and continence care, I felt this would strengthen my
study.
I explained to Sam that I was completing a case study on an
incontinence issue, that I found his case interesting and that
I previously had limited knowledge on both anal squamous
cell carcinoma (SCC) and chronic radiation proctitis (CRP). I
explained to Sam that all information would be kept strictly
confidential and that his name would be changed in the case
study to protect his identity. I also explained he could withdraw
his consent and change his mind at any stage. He discussed this
with his wife and then consented to being my ‘subject’ in my
case study.
*Names have been changed to protect the identity of the case
study participant.
case study
Faecal incontinence is a significant problem experienced by
approximately 1.4% to 4.4% of the population 1, 2. Only one-third
of those with faecal incontinence will mention their condition to
their doctor or healthcare professional 3. Although incontinence
is not life-threatening, the costs associated with its management,
together with its stigma, potentially intensifies stress and anxiety,
significantly impacting on individual’s and their family’s quality
of life 4. Some people are embarrassed by their incontinence and
limit their activities, due to the discomfort from perianal skin
problems, irritation and odour, all of which contribute to social
isolation, low self-esteem and sexual dysfunction 5.
Faecal incontinence can affect anyone; however, research
indicates that age, gender, medical conditions and certain
diseases and their treatment may be predisposing factors 6.
While faecal incontinence can be greatly improved or cured, for
some, their life is constantly controlled by their incontinence 6.
This case study will discuss the assessment, management and
complications experienced by Sam, who was diagnosed and
underwent treatment for anal squamous cell carcinoma (SCC)
and subsequently developed chronic radiation proctitis (CRP).
Anal cancer has a similar aetiology to genital malignancies,
rather than of the gastrointestinal tract 7. Treatment involves
10
radiation and chemotherapy 8, both of which Sam had. The
use of radiation therapy has increased over the last 25 years,
leading to significant improvements in patient prognosis 9.
However, complications, including CRP are potential side
effects. Significant epithelial damage, atrophy and fibrosis
associated with obliterative endarteritis and chronic mucosal
ischaemia result in ischaemic intestinal segments that are then
prone to stricture formation and bleeding 9. Clinical symptoms
of radiation proctitis injury usually begin months to years after
the radiation treatment, with the median time of onset after
exposure ranging from eight and 13 months, but with latencies
up to 30 years 10.
CRP symptoms include diarrhoea, mucosa rectal discharge,
rectal bleeding, rectal pain, urgency and, less commonly,
faecal incontinence 9. Flexible sigmoidoscopy, colonoscopy and
biopsies can be performed to assess the extent and severity
of the radiation injury, and differentiates diagnosis between
recurrent tumour and radiation proctitis. Radiation proctitis
occurs in up to 30% of people and is a common complication
of radiation therapy to the lower abdomen and pelvis 11. Sam
developed CRP 10 months following his radiation therapy.
Approximately 85% of cases of CRP present within the first
two years after radiotherapy. The true incidence is unknown
and estimates from retrospective data suggest that between
two and 22% of patients who receive radical pelvic radiation
may be at risk of developing CRP 9. The risk will be influenced
by both treatment; dose per fraction; total dose; technique
and patient factors including diabetes, inflammatory bowel
disease, hypertension or peripheral vascular disease 12. Current
treatments for CRP include pharmacological agents of steroids,
administered either per oral or rectally five amino-salicylates,
sucralfate, short chain fatty acid enemas, oral metronidazole,
oral vitamins E and C 13. Haemostatic treatments include topical
formalin, hyperbaric oxygen therapy (HBOT) and, for severe
cases, surgical intervention including faecal diversion may be
required 14.
An analysis of Sam’s medical history, including detailed
questioning, particularly focusing on the onset of his incontinence,
symptoms, histopathology and his previous treatments, was
vital in assessing the severity of Sam’s incontinence and factors
that influenced my management plan. Sam was a retired 58
year-old-male, married with two children. He had a medical
history of reflux and nil known medication allergies. He was a
non-smoker, social drinker and was previously fit and healthy.
In 2005, Sam was diagnosed with anal SCC T3N2M0. (The TNM
staging system classifies malignant tumours according to the
characteristics of primary tumour, T, involvement of lymph
nodes, N, and absence or evidence of Metastasis, M. Stages
are classified as 0, 1, 111, 1V) 6. He subsequently underwent
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combination chemotherapy and radiotherapy and in 2006
was diagnosed with CRP, which was confirmed by a flexible
sigmoidoscopy. An excision biopsy of his anal canal indicated
radiation-induced changes, but showed no recurrent or residual
tumour. Skin and anal biopsies were also taken, which showed
benign condyloma and slight koilocytosis were also present
in his superficial epithelium, suggesting that it was Human
papillomavirus-related. His local doctor prescribed Sam with
Rectinol and Xylocaine to assist with his excoriated perianal
skin. He was ordered a CT scan of his chest, abdomen and
pelvis. The results showed a 3mm cyst on the left lobe of his
liver, but indicated no further spread of carcinoma, to the relief
of Sam and his family.
Sam experienced daily faecal urgency, diarrhoea, rectal bleeding
and mucous discharge. Initially his surgical doctors prescribed
one tablespoon of psyllium husk each morning, but his doctors
soon increased the dose of psyllium husk to twice a day, hoping
to reduce his bowel movements. His radiation oncologist
prescribed sucralfate enemas twice a day for four weeks, but
Sam experienced an increase in diarrhoea and decrease in energy
levels. According to Tagkalidis and Tjandra 9, they acknowledge
that these treatments have been used in assisting to improve
CRP; however, they also state that evidence to support this is
lacking in randomised controlled trials and retrospective series 9.
Despite pharmaceutical attempts, Sam continued to experience
faecal incontinence. At this point, his CRP was dominating
his life. He was again reviewed by the radiation oncologist,
who discussed with Sam possible surgical options for faecal
diversion; including abdominoperineal resection (APR) or end
colostomy. This had not previously been discussed, as surgery
is considered the last resort in the treatment of CRP and results
cannot be guaranteed 11. Postoperative complications need to be
considered when discussing the potential benefits versus the
risks of each surgical procedure 15. Sam was now informed and
aware of his options; however, remained eager to explore other
medical treatments before undergoing surgery. HBOT treatment
has previously been described as a non-invasive therapeutic
option for the treatment of CRP and is also used for the treatment
of non-healing wounds in the anorectal area after conventional
therapy has failed 16. The HBOT treatments involved a 90-minute
session, five days a week for approximately eight weeks, which
Sam received. The response to HBOT-mediated tissue hyperoxygenation is the stimulation of angiogenesis and reduction
of tissue oedema, leading to normalised tissue metabolism and
tissue regeneration 17. Unfortunately HBOT was unsuccessful in
treating Sam’s incontinence.
Sam’s failed treatments included loperamide, lomotil, psyllium
husk, steroid enemas, mesalazine, oral antibiotics, aminosalicylic
suppositories, analgesics and HBOT. In January 2009, Sam made
the decision to undergo surgery in a desperate attempt to regain
his continence. Preoperative education was given to Sam for
the formation of end colostomy 18,19. Sam was prepared and
accepting of his anticipated surgery and was looking forward
to an improvement of his incontinence. Following his initial
diagnosis of anal SCC in 2005, Sam underwent a laparoscopic
end sigmoid colostomy in 2007. Following surgery, Sam’s
perianal area remained extremely excoriated and continued
incontinence of rectal bleeding and mucous discharge occurred
12
up to eight times per day. The surgeons requested input from
the wound ostomy continence (WOC) nurse to review Sam’s
ongoing perianal excoriation and faecal incontinence.
For the WOC nurses, it was necessary to determine the nature of
Sam’s incontinence. It was evident from Sam’s medical records
that it has been confirmed that the faecal incontinence was
caused by CRP, not haemorrhoids, recurrent tumours, fistulas,
or poor perineal hygiene. An interview was performed with
Sam, investigating his bowel pattern. Sensation of urge, number
of movements per day, consistency, ability to defer defecation,
presence of flatus, soiling, pain, presence of mucous or blood,
pad usage, fluid intake, toilet access, past medical and surgical
history and medications were areas covered in helping us
establish a management plan.
Sam was cooperative and had emotional support from his
family and friends. Informed consent was obtained for each
procedure. Sam was encouraged to ask questions and was
aware of the WOC contact details. Education plays a crucial role
for continence advisors. Education, understanding, treatment
and compliance are crucial for the success of the management
plan 20. Sam was motivated and hopeful, but was also fearful
that the treatment would again be unsuccessful in regaining his
continence, due to his previously unsuccessful attempts of other
invasive treatments, particularly his colostomy.
After confirming the nature of Sam’s incontinence, it was necessary
to determine the impact of the incontinence on Sam’s lifestyle and
quality of life. This assessment offers the opportunity to both
empathise with Sam and to understand pertinent emotional and
social factors in the manifestation of his symptoms 21.
Physical assessment of Sam’s perianal area was performed,
which included skin and rectal examination, pain assessment
and observation of the amount of mucous present. From the
assessment findings, it was noted that Sam had severe perianal
excoriation due to multiple bowel motions and, following
per rectal examination, mucous and blood was observed on
a gloved finger. The plan was to trial rectal irrigation and to
monitor Sam’s progress, as research indicates this can improve
faecal incontinence 22. Sam received a rectal washout with 60ml
of tepid water using a 14 French Foley’s catheter, irrigating
pre- and post-one microlax enema. The aim was to reduce the
mucous output and frequency, leading to reduced incontinence.
Sam was instructed to observe for rectal discharge. He stated he
had nil mucous discharge, only water. Calmoseptine cream and
stomahesive powder was recommended and used to protect and
soothe the excoriated area 23. Sam was encouraged to continue
using the cream and powder as required. He was encouraged
to keep a bowel pattern diary, making notes of the time, colour,
amount, odour and leakage onto his pad and the consistency of
his discharge. He was scheduled to return in 48 hours for review.
Documentation was recorded.
Sam continued to experience perianal excoriation due to his
frequent rectal incontinence of mucous fluid up to eight times
per day, despite having a colostomy. Irrigation was repeated,
and the perianal area was again treated with cream and
powder. Sam was again instructed to return in 48 hours. He was
instructed to collect a faecal specimen for the WOC to review at
his next visit. Documentation was recorded.
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Sam’s specimen was a clear, jelly-like consistency mucous.
He indicated no change in bowel frequency or amount since
beginning rectal irrigation; however, was happy to continue with
this treatment. Sam’s perianal skin improved significantly with
the regular use of calmoseptine cream and stomahesive powder.
Sam mentioned this had greatly improved his comfort. Sam was
instructed to return in 48 hours. Results were documented.
Sam continued having rectal irrigation and, following a review
from his diary, it was observed a reduction in the frequency
of discharge. Sam and his wife were educated how to irrigate,
promoting independence and reducing the number of visits.
This was conducted every three days at home and Sam was
scheduled to return in seven days.
Following his irrigation regime, Sam’s incontinence episodes
were improving. He was having days of complete continence,
and his incontinence episodes had reduced. He was encouraged
to continue irrigation with 60ml of tepid water every four days
at home. Sam opted to wear a small pad for security and this
give him confidence. He was discharged from the WOC team;
however, was encouraged to contact the team if he has any
further issues or concerns.
summary
The continence management plan was individualised for Sam’s
needs. Initially treatment and review were required frequently;
however, appointments gradually decreased as the goals that
were set were being achieved. Irrigation produced positive
outcomes; therefore, this was continued as required. Sam was
encouraged to ask questions and be actively involved in his
own care. He was encouraged to keep his bowel pattern diary
to indicate progress and encouraged to use calmoseptine cream
and stomahesive powder to aid healing. He was educated
and aware of the incontinence aids, giving him options with
available products. Documentation of each assessment was
recorded. A holistic approach was imperative at each visit. On
evaluation, the management plan was effective in improving
Sam’s continence and quality of life 24. His privacy and dignity
were respected at all time and informed consent was obtained
prior to all procedures.
The management plan was evaluated by reviewing Sam’s
progress through the documentation from each WOC nurse
visit, through Sam’s bowel pattern diary and from his own
physical and emotional wellbeing. From this, the WOC nurse
was able to evaluate the effectiveness of the management plan,
by establishing that intended goals were met, as incontinence,
skin integrity and self-esteem improved.
In conclusion, it can be seen in Sam’s case that surgical
interventions are not always successful to treat CRP. Rectal
irrigation was trialled to treat Sam’s faecal incontinence, despite
limited research identifying its significance. For Sam, following
failed medical and surgical interventions, the use of continued
irrigation combined with calmoseptine and stomahesive powder
significantly improved his quality of life. Having the ability to
make informed decisions and having a trusting relationship
with the WOC nursing team, combined with strong family
support, enabled Sam to regain his self-esteem and improve his
quality of life.
14
References
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2. Perry S, Shaw C, McGrother C, Mathews RJ, Assassa RP, Dallosso H,
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Castleden CM. Prevalence of faecal incontinence in adults aged 40
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3. Talley NJ. Prevalence of gastrointestinal symptoms in the elderly: A
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4. Johanson JF & Laffery J. Epidemiology of faecal incontinence: The
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6. Colwell JC, Goldberg MT & Carmel JE. Faecal and urinary Diversions:
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Anal Cancer incidence and survival: The surveillance, epidemiology
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evolving management strategies. Seminars in radiation oncology
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proctitis. Journal of the Indian Academy of Clinical Medicine 2005;
6:146–51.
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Goenka M, Gupta B & Mehta S. Radiation-induced proctosigmoiditis.
1991. Digestive Diseases and Sciences 36, 1, 103-107.
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in short term treatment of chronic radiation proctitis. Diseases of the
colon and rectum 1999; 42:788–95.
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double blind crossover trial with long term follow-up. International
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17. O’Sullivan B & Levin W. Late radiation-related fibrosis: Pathogenesis,
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M & Zubieta R. Initial assessment of incontinence n.d. 508–9.
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Fast Track Surgery – Should all components of fast
track surgery be introduced into the Australian
hospital system or certain aspects?
Lisa M. Wilson. RN, CNC Colorectal Perioperative Nurse, The Royal Melbourne Hospital. Vic.
Abstract
Fast track surgery is also identified as Enhanced Recovery after surgery (ERAS), multimodal surgery or optimization of care.
Fundamentally, the terms describe the principle of improving a patient’s clinical status prior to, during and after surgery. This is
said to be achieved through patient education, nutritional optimization, managing anaesthesia, pain and fluids optimally, while
encouraging patients to actively participate in their recovery. Fearon et al, as cited in the ASERNIPS 1 report, summarized core
protocol elements succinctly. After visiting hospitals in the UK that follow an ERAS model and attending a seminar at the Hvidovre
Hospital in Copenhagen with members of a colorectal team from The Royal Melbourne Hospital (RMH), Australia, the question
arises as to implementation of the whole or aspects of the clinical pathway. According to the ASERNIPS report 1, ‘Some units have
developed specific protocols for optimized surgery, while others have adopted individual elements in a piecemeal manner ’. Wind et
al. 2 suggest that some elements of fast track surgery are now incorporated in traditional care. This article attempts to examine aspects
of fast track surgery that could be introduced into the Australian environment and what is required to implement new protocols.
Considerations when assessing fast track are patient safety, readmission rates and cost shifting to the community environment 1. The
type of surgery examined in this article is colonic surgery, however, fast track has and can be used in other specialties.
Observing the preadmission process at St Thomas’s and Guy’s
Hospital (London), St Mark’s (London) and Hvidorve Hospital
(Copenhagen), there were some variations to the traditional
processes. Fast track surgery does not include bowel preparation
except for pre-operative enema’s, increased nutritional support,
carbohydrate loading two hours prior to surgery, differing
approach to pain relief and a heavy emphasis on patient
participation in their recovery. Patients were clearly told what
was expected immediately post operatively with regard to
mobilization, diet, less use of drains, pain control and discharge
date. Written material was provided. It appeared that the
length of stay (LOS) in the UK was not dissimilar to that at
RMH. However, there was a major difference with the LOS at
Hvidovre Hospital in Copenhagen, which is aimed at 3 days. In
a large consecutive series by Anderson et al.3 it was concluded
that ‘readmission rates fell from 20.1 % in 408 patients with a
planned 2-day hospital stay (period 1) to 11.3 % in 133 patients
with a planned 3-day hospital stay (period 2) (p <0.020).’ The
study found that the 3-day length of stay had a higher rate of
patient satisfaction while maintaining comparable complication
rates to traditional care.
Benefits of fast track surgery are of value if readmission rates
are similar to traditional care and patient safety is preserved
with no increase in morbidity and mortality. Gatt et al.4 say
that a shorter LOS should not be the only primary objective.
Mortality, morbidity, quality of life are of concern but the
primary concern of physicians is safety 4, 5. Wind et al.2 conducted
a systemic review of enhanced recovery programs in colonic
surgery. While there were limitations with the review, fast track
programs reduced time spent in hospital and were found to be
safe in major abdominal surgery. Factors in the success of the
program2 were dedicated, motivated and experienced teams.
Basse et al.6 found that younger people benefitted more from
fast track, however, gains could be achieved with patients
with a higher American Society of Anesthesiologists (ASA)
classification. Observation at the Hvidorve hospital and the
fast track system show some special features that need to be
achieved if embracing all key components. It is essential to
have a committed multi disciplinary team (MDT), investment
in staff training, preadmission protocols, anaesthetic and pain
protocols, a non-traditional ward environment, specialized
mobility aids and a discharge criteria to ensure safety.
An aspect that appears vital to the success of fast track is
commitment to MDT care 1, 2, 7. The UK, Copenhagen and
Australia are embracing MDT meetings with members including
surgeons, specialist nurses, medical oncologists, radiologists,
pathologists and other allied specialists. The UK is well
supported by MDT coordinators who are integral in liaison,
collating information, obtaining notes, completing proforma (for
notes, G.P & the MDT office) and maintaining statistics 8. In the
Copenhagen there was a strong team commitment to fast track
surgery. All team members were seen as critical to the success of
the program. The team presenting at the seminar at Hvidovre
Hospital included surgeons, senior nurses, anaethetists and
emphasis was placed on the importance of ongoing research and
the inclusion of administrators.
Investment in multidisciplinary team training is important. All
staff require education in fast-track protocols to attain improved
outcomes. Basse et al. 9 compared conventional care patients
15
with an accelerated care group. The accelerated group was
not studied during summer breaks and national holidays. The
author suggests that intensive management at all points of care
is required with fast track patients and when key stakeholders
are unavailable variations in outcomes may occur. This was
identified in a multicentre trial 10 whereby introduction of
protocols was not enough to achieve standardized results. Other
factors such as experience and care organization were seen as
important. Maessen et al.10 states that adherence to postoperative
protocol is most difficult to maintain due to frequent changes
among more junior doctors and nursing staff, therefore, changes
within the organization and education are required. Patients
must be given the same messages from all team members and
a great deal of encouragement is required through the whole
continuum of care. Observation at Hvidovre Hospital indicated
that though there was less nursing time spent attending to
wounds, drains, intravenous therapy and observations, there
was more time spent talking, coaxing and mobilizing patient’s.
It is unknown to the author if there is any difference between
the fast track group and traditional care group with regard to
nursing time delivering pain relief.
White et al.7 conducted a literature review and identified
anaethetists as important for the implementation of fast track.
Anaethetists were described as ‘Understanding the importance
of coexisting diseases and taking appropriate steps to minimize
postoperative complications through appropriate use of
preoperative medications, selecting the optimal anaesthetic and
analgesic techniques, and maintaining normal organ system
function will lead to improved patient care at a reduced cost’ 7.
Preadmission processes that involve anaesthetic assessment and
identify issues result in better outcomes for patients. Integral to
the management of fast track of patients in Copenhagen is the
use of epidural analgesia with less use of opioid analgesic with
progression to non-steroidal anti-inflammatory drugs, cox-2
inhibitors and paracetamol 11. Epidural anaesthetics are less
widely used at RMH with a preference for patient controlled
analgesic. In discussions with both anaesthetic and ward staff
(RMH), there is resistance to the use of epidurals, probably
due to inconsistent and varying results when implemented.
This was not replicated at Hvidorve Hospital, where both
anaesthetic and nursing staff were well skilled and supported in
the use of epidurals. Epidurals were replaced up to three times
if problematic. No such assistance is available in many other
hospitals, especially after hours when pain teams or anaesthetic
cover may be unable to meet demand. Kehlet 12 suggests that
‘ Epidural analgesia might not be necessary in laparoscopic
colorectal and can be replaced with opioid sparing multimodal
analgesia’. Analgesia is a controversial aspect 1 of fast track
and not the aim of this article to enter the debate. Suffice to say
that many MDT’s will consider and formulate anaesthetic and
pain protocols to meet the needs of their patients and teams
providing care.
Other elements important in the care of patients undergoing
resection in the perioperative phase are reducing IV fluids to
1500 mls in 24 hrs and maintaining normal temperature with the
aid of warmed fluids and Bair-Hugger ® 6. The type of incision
preferred is a short midline or transverse incision 1, however,
16
with many surgeons doing laparoscopic surgery a minimally
invasive surgery criteria is met. The use of drain tubes and
nasogastric tubes is avoided 12 1 4. Gatt et al. suggest that there is
no evidence of benefit and they hinder the patient with regard
to mobilization and elevate patient distress. Prophylactic use
of antibiotics 1 prior to skin incision with both anaerobic and
aerobic cover is also part of the core elements.
An excellent part of the Hvidorve protocol was the use of mobility
devices. All patients were mobilized as soon as possible with an
adjustable frame that was extremely stable. They were height
adjusted and the patient’s arms rested comfortably in armrests
with upright handles to grasp. This device gave confidence to
both patients and staff caring for them. The patients used these
for the first 24 hours regardless of age or general health and could
cease use when not required. Mention of these devices has not
been obvious in the literature; however, there use could be vital
in the success of mobilizing patients quickly. Units embracing
fast track should consider purchasing such equipment. Patient
safety and confidence could be enhanced. The ward was of
interest as a four-bed section had been converted for fast track
patients to walk too for meals, obtain refrigerated nutritional
supplements and watch television if desired. This is easily
achievable in other Australian hospitals but there would be
resistance due to a reduction in overall bed numbers. New
hospitals being designed should have these considerations
designed at the planning stage. Improving patient’s ability to
ambulate will surely improve earlier rehabilitation. Eating meals
in bed or beside the bed was discouraged. The corridors were
wide encouraging mobility contrary too older style wards that
dissuade mobility with trolleys and other hospital equipment
reducing the carriageway. Alcoves where patients could sit and
take advantage of the sunlight are beneficial for patients in a
cold climate. In summary, three key aspects were effective in
assisting patients to safely rehabilitate; mobility devices, patients
ability to move unencumbered and ward areas that encouraged
ambulation.
Lastly, two aspects to discuss are clinical guidelines and discharge
criteria. Observation at Hvidovre Hospital indicated that the care
plan was rigorously adhered to and staff were well versed in the
care of these patients. The plan includes pain control, removal of
urinary catheters, nutrition, mobilization and elimination which
were closely followed and documented11. Care plans adjusted to
fast track could be easily created at individual hospitals to best
suit their units. The need for a clinical pathway to ‘secure daily
tasks, to facilitate education of new personnel as every aspect of
care must be carefully explained’ 7. Introducing fast track throws
up common challenges to units implementing protocols7, one
of them being deviating from long standing surgical nursing
principles. White et al. 7 suggest that MDT meetings before
and after introduction include presentation of data on fast
track versus traditional care with goals and results to compare,
thereby increasing chances of success. Lastly is the issue of
discharge criteria. The criteria at Hvidovre Hospital is that
the patient is confident about discharge, eating and drinking
sufficiently, oral analgesic is effective and tolerated, the wound
is satisfactory, they are passing flatus and bladder function is
satisfactory 3, 11.
Conclusion
When assessing the introduction of fast track surgery into the
Australian environment there are many elements that can be
introduced but they require financial, organizational and a
team approach to change. Ideally a coordinator is required to
facilitate communication and protocols that can be agreed upon.
There needs to be strong a commitment to multidisciplinary
team meetings and willingness to alter traditional practice.
Preadmission protocols can be adapted in already established
departments to accommodate changes in dietary modifications,
bowel preparations and patient education. Intraoperative
protocols can also be changed with a team approach and
education. Changes in drug routines, reducing IV fluids,
maintaining normathermia, reducing use of drains, antibiotic
regimes and oxygen therapy are components in traditional
care and would require adjustment to the fast track approach.
Surgical techniques are moving towards laparoscopic methods
of surgery that fulfill a minimally invasive approach. Substantial
investment is required in staff education 10, effective equipment
for mobilizing patients and some ward modification to assist the
patients and staff to achieve goals. Teams need to review and
implement protocols to suit their patient population and work
within the staffing and ward constraints that are peculiar to all
institutions. With some pilot programs having commenced in
some Australian Hospitals, the way is open for certain protocols
to be adopted widely.
Bibliography
1. www.health.gov.au/surgery/pubs.htm.
2. Wind J, P.S., Fung Kon Jin P, Dejong C, von Meyenfelt M,
Ubbink D, Gouma D & Bemelman W, on behalf of the
Laparoscopic and/or Fast Ttack Multimodal Management
Versus Standard Care (LAFA) study group and the Enhanced
Recovery after Surgery (ERAS) group, Systemic rweview of
enhanced recovery programmes in colonic surgery. British
Journal of Surgery 2006. 93: p. 800-809.
9. Basse, L., et al., Colonic surgery with accelerated rehabilitation
or conventional care. Dis Colon Rectum, 2004. 47(3): p. 271-7;
discussion 277-8.
10.Maessen, J., et al., A protocol is not enough to implement an
enhanced recovery programme for colorectal resection. Br J
Surg, 2007. 94(2): p. 224-31.
11. Jakobsen, D.H., Clinical guidelines, Nursing Colonic
resection, Fast Track Surgery. Unit Of Perioperative Nursing.
2006: Copenhagen. p. 1-2.
12.Kehlet, H., Fast-track colorectal surgery. Lancet, 2008.
371(9615): p. 791-3.
WHO AM I?
I am known as the father of Australian multiculturalism.
I was a minister in the Whitlam government in the 1970s.
I reformed the Australian Citizenship Act and abolished the
procedural discrimination against Asians and Europeans
who had to wait longer than UK citizens for their visas.
During my time the number of people granted citizenship
increased by 48%. I also instigated the Racial Discrimination
Act, opposing all forms of racial discrimination.
I am known for my bright shirts and ties.
Email answer to: [email protected] or answer will
be in next journal.
3. Andersen, J., et al., Readmission rates after a planned
hospital stay of 2 versus 3 days in fast-track colonic surgery.
Br J Surg, 2007. 94(7): p. 890-3.
4. Gatt M, A.A., Reddy B , Hayward-Sampson P, Tring I
and MacFie J., Randomized clinical trial of multimodal
optimization of surgical care in patients undergoing major
colonic resection. British Journal of Surgery, 2005. 92: p. 13541362.
AASTN: values, purpose and vision
5. Kehlet H, W.D., Fast-track surgery. Br J Surg, 2005. 92: p. 3-4.
Quality, respect, accountability, commitment and innovation.
6. Basse, L., et al., A clinical pathway to accelerate recovery
after colonic resection. Ann Surg, 2000. 232(1): p. 51-7.
7. White, P.F., et al., The role of the anesthesiologist in fast-track
surgery: from multimodal analgesia to perioperative medical
care. Anesth Analg, 2007. 104(6): p. 1380-96, table of contents.
8. Trust, O.R.H.N., Operational Policy for Colorectal MDT
Meetings. 2008.
Our values
Our purpose
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Case study using Adapt Rings to prevent appliance
leakage
Anne Onions • RN, CNS, STN, Graduate Certificate in Community Nursing, Graduate Certificate in Palliative
Care, Graduate Certificate in Stomal Therapy Nursing
Overview
I received a phone call from the nurse unit manager at our local
hospital, requesting assistance with a patient who was having
problems with leakages from their ostomy appliance.
An elderly adult had suffered traumatic injuries that necessitated
the need for a colostomy. After the formation of the stoma and
recovery from the injuries, the client was discharged to a highcare facility as they were unable to empty the pouch or attend to
any stoma care. In this environment, the client began to recover
and decided to resume an independent lifestyle and left the
facility. This was against the advice of the facility.
Figure 1. Client in supine position.
20
The client was readmitted to hospital with stoma/gastrointestinalrelated problems. On meeting the client, I noticed that they were
wearing a closed, flat, one-piece ostomy pouch. I felt that a
drainable pouch would be more easily managed by the client.
The client wanted to be able to self-manage, as they wanted to
go home. Adults participate more responsively if they have a
‘need’ to learn and expect to be able to apply what they have
learnt immediately 1.
Problem
On removing the pouch I observed the stool was loose. I
also observed the height of the stoma (which was flush)
of each other and then applied this to the lower portion of the
aperture, of the convex, one-piece appliance, between 9 o’clock
and 3 o’clock. A skin prep was applied to the peristomal skin
and then the appliance. The skin is protected from moisture and
the shearing effect of tape or pouch removal by the plasticised
film of the sealant 2. This method built up the lower portion of
the adhering surface of the appliance to a more fitting shape for
the abdomen, particularly when standing. The client spent a lot
of time on their feet and was very active. An ostomy belt was
applied to the tags on the appliance to help maintain a gentle
pressure to prevent the appliance from lifting away from the
abdominal plane during activity. Extremely active people may
prefer the additional security provided by belts 2.
Outcome
Figure 2. Client in sitting position.
and the peristomal plane whilst the client was lying, sitting
and standing. The abdominal plane changed markedly from
flat whilst lying to standing (Figures 1 & 2). The stoma and
immediate peristomal skin retracted when standing, with a large
abdominal bulge immediately above the stoma (Figures 3 & 4).
Abdominal contours and the degree of stomal protrusion are
among the most important considerations in providing a secure
pouch seal 1.
Solution
The appliance required would need to be very simple to apply
and to fit the abdominal plane if leakages were to be prevented.
This method proved to be successful, as there were no further
leakages and after giving a demonstration on emptying this
pouch, the client was able to repeat the technique without any
problems. The client was discharged from hospital the next
day. Ongoing supervision or care was organised and the client
continues to have a more independent lifestyle.
Conclusion
It is crucial to look at the stoma, abdominal plane and abdominal
texture to be able to find an appliance that will be secure. The
learning abilities and capabilities of the client also play a crucial
role for the client in maintaining a secure pouching system.
Keeping the procedure as simple as possible makes it easier for
the client to learn.
The client had previously worn a one-piece, convex, drainable
appliance, but this had leaked. To obtain a secure seal, a pouching
system with support (rigidity) or convexity, or both, are required
for a patient with a soft abdomen and a flush or retracted stoma 1.
To create a more conforming appliance to fit the abdominal
plane, I cut a Hollister Adapt Ring in half, put the halves on top
References
Figure 3. Client in standing position.
Figure 4. Client’s view of stoma whilst standing.
1. Hampton BG & Bryant RA. Ostomy and Continent Diversions:
Nursing Management. St Louis, Mosby Year Book Inc, 1992.
2. Blackley P. Practical Stoma Wound and Continence Management.
Vermont, VIC, Australia, Research Publications Pty Ltd, 2004.
21
Enhanced recovery after surgery (ERAS): a multidisciplinary course for
specialists, nurses, dietitians and physiotherapists: 23 April 2010, Auckland, New
Zealand
Report for Executive Committee: Australian
Association of Stomal Therapy Nurses (AASTN)
Diana Hayes
Acknowledgement
Biennial travel grant awarded by the AASTN
I wish to kindly acknowledge the outstanding support of the
AASTN in the awarding of a travel grant. The grant is awarded
every two years to encourage and allow stomal therapy nurses
to travel abroad and learn from a diversity of cultures and
nursing models. This knowledge is then shared amongst the
members of the AASTN. My objectives were to:
1) Attend a study day in Auckland, which was titled Enhanced
recovery after surgery (ERAS) in April 2010.
2) Participate in a private tour of a hospital in Auckland which
had implemented ERAS.
This report outlines the ERAS model and describes how the
model has been adapted by an Auckland hospital, with the
expected outcomes of earlier discharge, reduced postoperative
fatigue and fewer postoperative complications. The information
in this report has been generated from the study day notes,
personal conversation and observation. I wish to thank the
organisers and the healthcare team involved in ERAS for kindly
sharing their information.
Figure 1. Jerusalem Inn, Nottingham. The oldest inn in the United Kingdom.
Sourced from: http://www.infobritain.co.uk/Trip_To_Jerusalem.jpg
Dr Lobo started his presentation by proudly showing the oldest
inn in England, which was built in 1189 AD (Figure 1).
Dr Dileep N Lobo was an invited guest speaker from Nottingham
Digestive Diseases Centre and NIHR Biomedical Research Unit
in the UK.
In regard to surgery and recovery, Dr Lobo spoke about getting
the fluid balance right. An infusion on day 1 post-surgery
might be Dextrose/Saline with KCL 30–40mmol per litre.
Two litres would usually be infused in 24 hours. Five per cent
Dextrose is not used and Plasmolyte is not readily available
for maintenance. He suggested that the best way to monitor
a person’s fluid balance is to weigh them daily. He said that
an increase of greater than 2.5kg would be a concern for him.
Frusemide is only used in small doses if required; for instance,
10-20mg to produce a diuresis. The trend of the output should
first be checked.
Unfortunately, due to the European air problems, he was
not able to fly out to participate and present in person.
However, the technology available enabled Dr Lobo to speak
via teleconferencing. His presentation was as good as if he was
standing in the room. The only drawback for the presenter was
the time difference between the two global regions; he was,
therefore, invited to present first.
Dr Lobo then discussed the pitfalls with allowing junior medical
staff to decide which IV fluids to order. He said that fluid
prescription plays an important role in morbidity and that
postoperative oedema is a complication, which should be
avoided. He even went as far as to say that normal saline should
be renamed abnormal saline. He said that Hartmann’s Solution is
a much better alternative as normal saline can lead to acidosis.
Eighty-six participants from both Australia and New Zealand
attended this course. It was held at the Heritage Hotel, Auckland,
New Zealand.
Perioperative fluid management
22
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In summary he said that:
• New care maps need to be created and printed.
• We should give the right amount of the right fluid at the right
time.
• Discharge planning must be a major aspect.
• Poison is in everything and nothing is without poison. The
dosage makes it either a poison or a remedy.
What is ERAS and how did it originate?
Dr Andrew Hill is a colorectal surgeon at the Middlemore
Hospital and the University of Auckland in New Zealand. After
finding out about the ERAS model in Copenhagen, Dr Hill,
along with two registered nurses, visited Copenhagen.
According to Dr Hill, ERAS:
1) was developed by Kehlet et al. in Denmark
2) is also known as fast-track care. However, he pointed out
that this sounds too much like trying to discharge patients
earlier without adequate preparation
3) is aimed at getting people better, quicker
4) is gaining global acceptance
5) sas described in the initial stages for open surgery but is now
also used for laparoscopic procedures
6) is used for a variety of operative procedures including
colectomy, prostatectomy and lung lobectomy.
What is so special about ERAS?
Some important features of ERAS are omitting bowel
preparations (preps) for people having colonic surgery. It
was argued that this does not include rectal procedures, as
an empty rectum is required for rectal anastomosis. Incisions
are made as small as possible, opioids are avoided and the
urinary indwelling catheter (IDC) is removed earlier than in the
traditional postoperative model of care. Also drains are not used
unless absolutely necessary and nasogastric (NG) tubes are not
routinely inserted intraoperatively.
To implement ERAS into a traditional hospital setting:
• The medical staff need to be educated.
• The nursing staff need to be educated.
• The physiotherapists, dietitians and others need to be
educated.
• The clerical staff need to be educated.
• Allowances for turnover of staff need to be taken into
consideration.
• The patients need to be educated.
• The family/carers need to be educated.
• Community healthcare workers and GPs need to be educated.
Also:
• New policies and procedures need to be in place.
24
• Patient histories and bed notes should be well flagged as
participating in the ERAS programme.
The following section outlines the care map for a patient who
requires colonic resection.
Colonic resection – preoperative preparation:
After being deemed as suitable and agreeing to be involved in
ERAS, the patient is given a half-hour intensive educational
session one to two weeks prior to surgery in the pre-admission
clinic. Because the clinic is in close proximity to the surgical ward,
the patient is also given a tour of the ward. This has proved to be
an excellent way of alleviating stress and fear, as the patient can
see, firsthand, how well set up, welcoming and comfortable the
ward is. One important initiative that has been implemented is
to rotate nursing staff between the pre-admission clinic and the
ward. This allows the patient to possibly have the same nurse
throughout their surgical experience. This epitomises primary
care nursing.
During the day prior to the operation, the patient drinks four
special carbohydrate (CHO) preparations. On the morning of
the surgery the patient drinks another two and fasts for only two
hours prior to the procedure. If the patient is having left-sided
colonic surgery, a rectal enema is given; otherwise no oral bowel
preps are required. Patients are admitted to the hospital on the
morning of the procedure. For pain management, a thoracic
epidural is used.
The type of incision used will be a transverse incision for rightsided surgery and midline or laparoscopic for left-sided surgery.
Drain-tubes and NG tubes are avoided. Intravenous therapy
(IVT) is limited to 1.5–2 litres.
Colonic resection – postoperative management – day of
surgery
Ondansetron is used as a first-line anti-emetic. On arrival to the
ward the patient is placed in a sitting-up position.
Two hours after return to the ward, the patient is offered a
protein drink and a sandwich. These are not forced upon the
patient, just offered. The brand used is Nutricia Fortisip. This is
a high-energy drink. It can be taken on its own and with meals.
It is not used as a meal replacement, but as a supplement to food.
Clexane is given at 1800 hours and TED stockings are worn to
prevent deep vein thrombosis (DVT).
The patient is sat out of bed for two hours on the day of the
operation. All usual postoperative observations are attended
and the care map is used. On the care map, only ticks are used
in the relevant boxes if the patient is recovering well. Any boxes
that have a cross require an explanation below that section on
the care map. A care map that has only ticks will indicate that
the patient is on track and that there are no complications. This is
known as charting by exception. Each nursing shift has a unique
colour code on the care map. Red is for night staff, blue is for
morning staff and black is for the afternoon shift.
Colonic resection postoperative day 1
Unless there is any clinical reason to maintain IVT, the IV
is removed the morning after surgery. The cannula is left in
situ. If epidural hypotension is reported, a pressor such as
Phenylephrine is used to treat it.
During the morning of day 1, the IDC is removed. The thoracic
epidural will remain in situ. The abdominal wound dressing is
removed. If the wound is healing by primary intention, it is left
exposed. If the patient has a stoma, a separate care map is also
provided.
On this day, all patients receive:
• An explanation of the operation
• The goals for the day
• Preparation for discharge
The epidural and IV sites are checked, vital signs are taken and
charted and normal diet and oral fluids are given. This includes
the Fortisip protein drinks.
Three bottles of Fortisip (Figure 2) are taken orally each day
whilst in hospital and five days’ supply is given to the patient to
take home on day of discharge. The cost is $1.00 per bottle. If the
patient has diabetes, then Diasip is substituted for Fortisip. Each
bottle contains 200ml.
Once the IDC is removed, the urinary output is monitored for
two or three voids.
The patient is assisted out of bed and has all meals in the patient
meal room with the other patients. The patient is kept out of
bed for two hours, twice, for each morning and afternoon shift
and is allowed to return to bed for short periods during the
day. Mobilisation is an important part of rehabilitation on day
one. Three walks are implemented on this day. Usually by the
evening, the patient is able to mobilise independently, with the
epidural infusion in tow.
Analgesia is managed orally with Paracetamol and NSAIDs.
Opioids are avoided. The care map is maintained. Intestinal
function is charted along with all other observations. Discharge
planning is activated. Five important features are:
• Family informed.
• Transport arranged.
• Home help.
• Medications discussed.
• Referrals as required (for example, community-based stomal
therapy nurse).
Colonic resection postoperative day 2
On the morning of day 2 at 0900 hours the epidural infusion is
ceased. If adequate analgesia is upheld, the epidural catheter is
removed at 1400 hours. This is in conjunction with the 1800 hours
Clexane dose. The patient continues to progress as documented
on the care map. The patient is given 15 bottles of Fortisip
for consumption at home, over five days. An appointment is
made for seven days post-surgery in the clinic for the removal
of staples and histology results with the consultant. Active
mobilisation continues.
Colonic resection post-operative day 3
The objectives for day 3 post-surgery are:
• Return of GI function.
• Ability to eat and drink without discomfort.
• Passing flatus.
• Had a bowel motion but not essential for discharge.
• Pain controlled with oral analgesics.
• Adequate home support in place.
An essential element of ERAS is having a discharge date target
but being flexible with it. If the patient is not ready for discharge,
they are able to have their LOS increased. The ward is able to
accommodate greater LOS as not all beds in the wards are used
at the same time to allow for this. The patient-staff ratio is 5:1.
Comparing ERAS with the traditional care model
Figure 2. Fortisip protein drink. Sourced from: http://upload.wikimedia.org/
wikipedia/en/6/66/Fortisip.gif
Dr Hill then discussed the differences between two groups of
people. The ERAS group and the control (traditional care) group
25
each consisted of fifty people. The differences can be seen in
Table 1.
ERAS group (n=50) TRADITIONAL
group (n=50)
Intraoperative
2
3
First three days
2
6.5
44 (89%)
38 (76%)
2
3
Days to 1st full meal
1
2
Days to passage of flatus
2
3
Intravenous fluids
Epidural analgesia
Number of patients
Duration of use (days)
Recovery
Days to independent
mobilisation
Physiological and Psychological Preparation
Dr Mattias Soop is a colorectal surgeon at the New Zealand North
Shore Hospital, who spoke about preparing the patient both
physiologically and psychologically. Dr Soop said to best prepare
patients for surgery, we should avoid unnecessary dehydration;
avoid unnecessary starvation; avoid unnecessary anxiety and
set realistic expectations. With adequate preoperative education
and management, there could be a reduction in analgesics by
50%, a reduction in time to first flatus by 38% and a reduction in
hospital LOS by 20%. Ideally the preoperative education is given
within one to two weeks prior to the operation day. A checklist
of the daily events is explained as well as the discharge criteria.
Dr Soop discussed the history of overnight fasting prior to
surgery. It originated back in 1848 when aspiration during
ether anaesthesia was documented. Dr Soop questioned the
need for overnight fasting when 200ml was needed for passive
regurgitation. The current preoperative fasting guidelines for
three countries were given. They are:
NZ: clear fluids two hours, solids six hours,
UK: clear fluids three hours, solids six hours
1
3
US: clear fluids two hours, solids six hours.
Thus, preoperative overnight fasting is now considered to be
‘history’.
Day stay
Number admitted >day 1
before surgery
12
29
Postoperative stay (days)
4
6.5
Total hospital stay (days)
4
8
In his summary to the session, Dr Soop stated that preoperative
education might be the most important intervention in enhancing
recovery. He also said that oral bowel preparation does not
improve clinical outcomes in colonic resection but may cause a
small increase in surgical wound infections.
Readmissions
His recommendations for the ERAS model are:
Number of patients
readmitted
• An emphasis on preoperative education.
6
7
Total day stay added (days)
73
44
• Omit bowel preps (left-sided colonic resections may still
need an enema).
• Allow clear fluids until two hours prior to surgery.
Table 1. Sourced from: Dr Andrew Hill, ERAS course notes, April 2010.
Dr Hill pointed out that one of the most significant factors was
the reduction in hospital LOS from an average of 6.5 days in
the control group to 4 days in the ERAS group. He also stated
that removal of the IDC whilst the epidural was still in situ was
beneficial. Furthermore, it was noted that postoperative fatigue
was reduced and that ERAS patients recover better and quicker.
Dr Hill then offered a differential cost analysis. His equation
was:
Savings on day stay + complications MINUS full
implementation + maintenance cost
$446,000 – $102,000 =$344,000 =$6880 per patient.
In his conclusion, Dr Hill declared that ERAS is possible, safe,
enhances recovery and is cost-effective in a New Zealand
hospital.
26
• Use CHO oral preps prior to surgery.
Breakout Session: Nursing Aspects of ERAS
Lisa Thompson, registered nurse, at Manukau Surgery Centre
led the breakout session for postoperative care and nursing
issues. This was an excellent session as Lisa was able to answer
all of our queries and concerns. Lisa presented two case studies
of ERAS patients.
1. A lady who was 102 years old was discharged home on
day 3 following a right hemicolectomy. There were no
complications or post-discharge issues.
2. A man who was 79 years old who was discharged home on
day 5 following anterior resection and loop ileostomy. Six
weeks after discharge he participated in a high-level squash
tournament and played three games. He was given special
exercises during his recovery phase by a physical trainer
Figure 3
All patients are given a post-discharge telephone call to check
that they are managing at home. All patients are given a direct
ward telephone number to call if they have any questions or
concerns. All calls are logged in a special book.
I was very fortunate to have been given a private tour of the
surgical ward the day prior to the study day, by Lisa (Figure 3).
Lisa showed me the state-of-the-art call bell system used in the
wards. When the nurse call bell is pressed, the nurse in charge
of that patient’s care will receive notification via his or her own
pager. If the call is not attended within 90 seconds, the pager of
another nurse on the ward is activated. If the emergency alarm
is used, the alert goes directly to the doctors’ pagers rather than
sounding an alarm on the ward.
Figure 4
Each patient’s history, radiology pack and so on, remains in a
purpose-built compartment outside the room within the wall
(Figure 4). There is a security mechanism so that only staff
can access it. Once opened, the compartment door is used as a
writing table (Figure 5).
Conclusion
I wish to thank everyone involved in this experience: The
Australian Association of Stomal Therapy Nurses; the organisers
of the ERAS study day and the doctors and nurses for sharing
their invaluable knowledge and experience. I also wish to
acknowledge and send a very special thank you to Tzu Chieh
(Wendy) Yu for being my contact in New Zealand and for
organising my visit to the Manukau Surgery Centre.
Figure 5
27
Continuing professional development (CPD) made
easier
Are you doing it tough at work and think you are unable to
find the points you need to submit a CPD record for AASTN
recognition?
Part 1
In addition to the data on the CPD portfolio, you could consider:
• Placing the CPD record (the AASTN one or another of
your own devising) on your computer desktop or office
noticeboard, where it is readily visible and easily accessible.
• Placing a loose-leaf folder at the front of the top drawer of
your filing cabinet for hard copies of evidence (invitations to
present an in-service/tutorial/workshop/study day topic/
ostomy association presentation/parents’ and teachers’
meeting presentation on assisting children cope with their
stomas or continence issues at school/participate in a
newsletter development and so on).
JSTA and ask for suggestions or feedback.
• Offering to host a Big Morning Tea for the Cancer Council.
• Participating in formal product trials, or recording your own
reflections on various products, sufficient to make a change
in your practice. Tell others about it.
This is not an exhaustive list, but are some of the ideas gleaned
from other STNs who have commented and experienced some
of the same issues about reaching 100 points.
Still think you can’t?
Discuss your predicament with an Education and Professional
Development Subcommittee member (E&PDS). The contact
details can be found on our website: www.stomaltherapy.com
• Similarly, create a separate folder in your email for any of the
above invitations/activities that come via email so that they
are easily retrieved for submission.
Part 2
• Completing an online educational module, for example,
WoundsWest.
professional issue question. Submit your answer with your
• Visiting pertinent/relevant websites and providing feedback
to JSTA on where educational materials for STNs, patients,
nursing staff or doctors can be found.
A professional issue • Providing feedback to those websites about their educational
material.
• Identifying errors or issues in textbooks and writing to the
author or publisher.
• Preparing a written submission to your agency’s Staff
newsletter, accreditation panel, or a journal about STN
activities/Stomal Therapy Awareness Week and so on. Even
if it is not published, add it to your file, as you have had to
research the data and thus have expanded your knowledge.
• Attending and contributing to meetings in your agency
related to policies, procedures or competencies, whether
directly STN-related or not.
The E&PDS would also like to add a further opportunity for you
to earn 10 points by researching and answering the following
portfolio.
(CPD – 10 points)
Stomal therapy nursing involves an autonomous approach
to practice: often the stomal therapy nurse works alone when
providing a specialty nursing service across a hospital or other
health facility.
(a) Briefly discuss boundary setting in relation to the practice of
stomal therapy nursing.
(b) List strategies the stomal therapy nurse might use for setting
and maintaining boundaries in order to promote professional
nursing caring.
Conclusion
• Recording your participation in your agency’s mandatory
competency requirements – these are all part of your CPD.
Members of the E&PDS are very willing to discuss your
• Reviewing that new book on professional issues/breast
care/continence/ostomy and wound management you
received or bought – you will have done this informally, but
why not convert this into a ‘formal’ review and submit it to
the JSTA for everyone’s education.
in the AASTN CPD process. We believe all STNs are trying
• Identifying in writing that ‘niggling problem’ you confront
regularly and actually spend a little time considering how to
solve it. Tell the rest of us about it in a short item of interest
in your state’s newsletter, meeting, educational event and the
28
circumstances and try to assist with options for your participation
to keep up to date in a variety of ways and, as a professional
organisation, support these efforts. Let us know whether these
tips have helped and please offer any more from your own
experiences. Happy ‘developing’.
Lorrie Gray
On behalf of the AASTN Inc Education and Professional
Development Subcommittee
Leaders in practice
Captured in paradise
3–7 July 2011
CONFERENCE PLANNING UPDATE
The agreement is that AASTN will hold its national conference
at the same venue and at the same time as the colorectal
tripartite conference meeting. AASTN is organising its own
programme, with sessions runing concurrently with the
tripartite programming. So, if you provide an abstract or are
considering a talk, this will be presented to a nursing audience.
There are two exceptions to the above statement: firstly, we will
not programme against their keynote speakers and secondly,
we will be programming three or four joint sessions with the
tripartite group. These workshop-style sessions will explore
topics similar to both groups, for example, evolution of the nurse
practitioner in the colorectal speciality, or say multidisciplinary
team approach in total patient care.
The social programme will be a joint venture and both groups
will enjoy the same social time and functions. These to date
include: welcome conference drinks on Monday evening on the
beautiful foreshores of Cairns esplanade, Conference dinner on
Wednesday evening and an afternoon on Tuesday exploring
the famous Kuranda Scenic Railway and surrounds. If there are
sufficient numbers, then a day tour of the Great Barrier Reef will
be organised as a private trip for our conference delegates at the
completion of both conferences on the Friday.
The trade display will be set up in a large area of the convention
centre and will be in the same area as the tripartite trade
partners. Delegates will have the opportunity to visit a trade
display that will incorporate more companies and variety than
we have been used to at past conferences.
The AASTN Conference programme will run for three days,
Tuesday 4 July to Thursday 6 July 2011 inclusive. However,
registration to our conference will be inclusive of the Tripartite
programme, which commences on Monday 3 July and so,
if delegates can spare a full week off work, then they are
encouraged to avail themselves of the opportunity of attending
both conferences.
Tourism in Cairns is their number one industry, with an
international and domestic airport located 10 minutes from
the city centre. Daily flights originate from all capital cities in
Australia. As the conference dates are in the middle of school
holidays, we encourage all families, where possible, to make
this a holiday. For this reason, we will organise a partners’ social
programme during the day and our conference secretariat will
source accommodation suitable for delegates and families.
• National and international airport, just 10 minutes from the
town centre, only $10 cab fare.
• Accommodation will be recommended and block bookings
made for delegates, ensuring best rates possible, with most
accommodation within easy walking distance to the Cairns
convention centre.
• Casino is within five minutes’ walking distance from the
convention centre and walking distance to all amenities.
• Family-friendly city, with a partners’ programme organised
during conference days.
• Joint conference, giving a wider selection of topics and
speakers, with the opportunity to move between sessions
depending on your programme interests.
• Networking with surgeons and colleagues.
• On your doorstep are two natural wonders of the world: the
Great Barrier Reef and the Tropical Wetlands.
The committee is currently seeking expressions of interest or
poster presentations, with particular emphasis on, but not
limited to:
• Practice innovation.
• Case studies – included in this burns or atypical wound
representations.
• Research.
• Multidisciplinary team approach.
• Community or remote area nursing.
The official call for abstracts with presenter guidelines will
be issued in the next journal. However, if you are interested,
these guidelines can be e-mailed on request. The Conference
Committee members are:
Jenny Davenport
Andrea Farrugia
Helen Nodrum
Loreto Pinnuck
Wendy Sansom
Lisa Wilson
Anita Lynch (trade liaison)
So why come to Cairns?
The Victorian branch is looking forward to providing all
delegates with a professional and informative programme, with
time for socialising and sightseeing in Cairns. The website link
to AASTN will be established by the end of June 2010.
• Perfect climate at that time of year: 18°C overnight, 27°C
during the day.
Helen Nodrum
[email protected]
29
AASTN website coordinator report
AGM March 2010
Karen McNamara (Cred) STN – AASTN Website Coordinator
When I accepted the role of AASTN Website Coordinator in
June 2009, with only very basic IT skills and knowledge, I was
hopeful that my enthusiasm for this position would make up
for my lack of IT experience. My goal has been to maximise the
use of our website to its full potential within a reasonable time
frame and budget and to enhance our scope of practice through
this vital IT network for the benefit of all our members and the
wider community.
National Executive, we have introduced a few initiatives that I
hope will enhance the website in keeping with our professional
expectations and standards.
• We now have a Yahoo ‘Search Tool’ at the top of the home
page to assist user navigation.
• We have retitled the events section to ‘News and Events’
with a drop-down menu for the state calendars, news and
With support from Phil Morton (AASTN Web Master), Lorrie
Gray (Education and Professional Development Subcommittee
[E&PDS] Representative) and the National Executive Committee,
I think we have managed to take a few significant steps towards
achieving this.
For the past year my aim has not only been to update and
maintain accuracy on the website but to assist with the ongoing
development to provide an informative, easily accessible and
user-friendly site, so users will not only return but may also
want to contribute and be an integral part of the AASTN.
In 2009, Lorrie Gray has contributed many positive and visual
improvements to the site on behalf of the E&PDS. We now
have a wonderfully warm and friendly photographic page,
displaying every E&PDS member with all their contact details.
A special photographic inclusion of some of our latest life
members, Julia Thompson and Cynthia Smyth, has also been
added. Lorrie has also written and submitted a draft for the
‘Benefits of being a member’ page.
conferences.
• A big thank you to all the State Representatives who have
dutifully provided me with their calendar contents for
publication, allowing us all some insight into the states’
activities in 2010. This set-up can be easily maintained to
provide an updated, accurate, monthly record of events,
meetings and professional study days.
• Last, but not least, with all the ‘bells and whistles’ for the
AGM to announce and launch today (12 March 2010),
our ‘Members-only log-in’ will be activated. Our devoted
Membership Coordinator, Robyn Simcock, will speedily
distribute 280 passwords via email to all our AASTN
members (except Corporate) in the coming week.
We are expecting this process to be a relatively straightforward
transition, as most of us will be familiar with many other
professional sites which provide a ‘Members-only’ option, but,
unlike some other sites, I would like to stress that, due to the vast
difference in ongoing costs to maintain this option, the password
Other aspects:
you receive from Robyn cannot be changed.
• Several patient information brochures have been revised for
download, with the rest to be available by the end of March.
Once we have the ‘Members-only’ access operational, The Journal
of Stomal Therapy Australia can be released for download and any
• The menu has been slightly rearranged to introduce a
dedicated section for ‘Scholarships and Grants’.
other privileged information we wish to provide for restricted
• In the publications section, the ‘Download’ title has been
changed to ‘Online Forms’.
Executive and State Branch Minutes made available online this
• We have included a few more website links, including the
‘Department of Health and Ageing’ and ‘Bowel Group for
Kids’.
I would like to take this opportunity to encourage everyone to
Meanwhile, I have established a successful working relationship
with Phil Morton and, in collaboration with Lorrie and the
will ensure this current and interactive resource will continue to
30
publication to members. We are hoping to have all the National
year and eventually online membership renewals.
have a look at and be a part of our website, by submitting any
suggestions, creative ideas and information to me or Lorrie. This
reflect a high standard of professional commitment.
ACSA report
Australian Council of Stoma Associations Inc. (ACSA)
The partnership continues
Peter McQueen • Vice-president ACSA
As with my previous contributions, I will progress the theme of
mutual benefit in cooperation between our two organisations
ACSA and AASTN. Although the roles of each organisation are
very different, the end result is very similar and that is someone
with a stoma who is well-adjusted, healthy and confident to
tackle life and whatever challenges it may bring. In Australia we
not only have access to the very latest in appliances through our
associations, but in most cases we have access to professional
healthcare from our stomal therapy nurses (STNs). Most ostomy
associations have an excellent relationship with their referring
STNs and a great number have an STN on staff to provide
professional care to their members. We must not take things for
granted and not lose sight of what we have. We need to continue
to nurture and enhance our cooperation at all levels.
I am pleased and proud to say that the cooperation between
Australian STNs and the ostomy movement is not confined
to Australia only. Two of your esteemed colleagues, Elizabeth
English and Carmen Smith, are involved in a ground-breaking
project in India. This is a joint venture between the International
Ostomy Association (IOA) and the WCET. Funding for the
project was obtained from the Access to Health Care Foundation,
established by the Coloplast Company. The total projected costs
for the project are in the vicinity of US$250,000. It is an e-learning
project to train nurses in stomal therapy in India, with theory
modules that will take 70 hours to do online. An exam will be
taken and then a practical module (70 hours/two weeks) in a
stoma care clinic by recognised STNs, chosen by the organising
committee. With the funding obtained, it is hoped to train more
than 1000 nurses over three years, greatly enhancing the lives
of people undergoing ostomy surgery. It is hoped that this
project will then be self-sustaining. It is also the intention to
make these training modules available through the WCET to
others. The WCET and IOA are involved in another joint project
in China, where the main focus is the establishment of ostomy
support groups (associations) in various cities throughout
China. Funding for this project has also been sought from Access
to Health Care.
World Ostomy Day was celebrated in October 2009 and a number
of associations did make the effort to involve themselves in the
day’s activities with various degrees of success. However, it
was disappointing to note that a number of associations did not
participate and this limited the effectiveness of the programme
in Australia for 2009. It is hoped that a bigger participation
takes place in 2012. However, World Ostomy Day proved to be
a great success in many countries throughout the world, with
the standout being Italy, where in excess of 800 people attended
an ostomy awareness day, concentrating on the theme Reaching
Out.
May our two organisations continue to work together for the
benefit of all.
Smith & Nephew
Stomal Therapy
Education Grant
The Smith & Nephew Stomal Therapy Education Grant
is awarded annually to financially assist a registered
nurse who is currently undertaking or has applied to
undertake a recognised AASTN Stomal Therapy Nursing
Education Programme. The award is administered by the
AASTN Executive but presented by Smith & Nephew.
The value of the scholarship is $1,000.
Selection Criteria and Guidelines
The applicant is to submit to the AASTN Secretary by
31 July 2010:
•A completed official application form which is to be
obtained from the Secretary.
•Proof that the candidate has been accepted, is
undertaking, or has completed a recognised AASTN
Stomal Therapy Nursing Education Programme
within the period January to December in the year of
application.
• A current curriculum vitae.
•Written confirmation from the applicant’s employer
that the candidate is able to utilise their stomal
therapy nursing skills on completion of the course.
Incomplete applications will not be considered.
The AASTN Executive will announce the successful
candidate within six weeks of the closing date.
31
WCET report
AASTN AGM
Brenda Sando CNC STN • The Wesley Hospital, Brisbane QLD
What a busy year we have had since my last meeting with the
Australian WCET members in Perth at our conference!
May I take this opportunity to congratulate the organising
committee of the conference, as it was one that will stand out
in my memory for many years as one of the best I have ever
attended.
We are fast approaching the joint WOCN/WCET conference in
Phoenix, Arizona, in June. I have heard that a number of our
STNs are going, which is great. It promises to be a great event,
with a very varied programme of speakers as well as a very
good poster presentation, the likes of which we have not seen
at our conference before. All the posters will be displayed in
one room, where at designated times the authors of the posters
will be in attendance for delegates to talk to as well as receive
handouts on their topic. I believe these sessions will be held over
a breakfast meeting, so not only can you receive food for thought
but also for your stomach.
It would be good if we could have as many of our Australian
members as possible attend the WCET general meeting to
support the outgoing President Elizabeth English (who is from
Australia) in this her last meeting. I would like to congratulate
Liz on the tremendous job she has done, in many different
and varied ways, not the least of which has been assisting the
website people to iron out some of the glitches in the system
to make it easier for us to log on, change our details when
necessary and make our annual payment. I am sure Liz will not
miss all the travelling and many late nights of phone meetings
with the Executive where most of the members are more than
twelve hours behind us.
Liz, Carmen Smith and Keryln Carville were in Iran last year
in conjunction with the WCET twinning programme bringing
enterostomal therapy education to nurses in that country. There
are many other activities in which Liz has been involved and I
am sure she will look forward to a well-deserved rest after the
conference. These roles are done while one continues to work
in their place of employment which contributes to the already
very busy role.
During the WCET meeting in Perth, our South Australian and
Queensland members presented letters of interest to conduct
the 2012 Congress either in Adelaide or on the Gold Coast.
Both groups put forward submissions with the assistance of the
convention centres in each state by the end of May to the WCET
Executive committee. Then came quite a long process of waiting
and a vote by the AASTN members as to where they believed
32
was the place to hold the congress before the decision was made
in August. A country who had shown interest in holding the
2012 congress withdrew their nomination just before.
I need to stress at this point, that Elizabeth English (WCET
President) and Carmen Smith (WCET Education Chairperson),
both from Adelaide, withdrew from the executive group who
were the decision-makers as to where the congress would be
held.
Fiona Bolton, from Adelaide, and I, as the Queensland
representative, were informed by email that the place nominated
by the AASTN members was Adelaide. I sent my congratulations
to Adelaide on a very professional submission and then the
work began.
No sooner was the ink dry on the paper, than Fiona was
gathering her team. I was delighted to be asked to be part of the
team and attended a meeting in Adelaide to choose a conference
organiser. An Adelaide group called SAPMEA was chosen and
we are well on the way to having a great conference in April
2012. You are doing a tremendous job in pulling the teams
together Fiona, and I know after Phoenix we will be involving
more of our Aussie STNs to assist in many ways. I do thank
those members who have already put their hands up to assist.
If you haven’t been given a job at the moment, don’t worry we
haven’t forgotten you.
Carmen Smith in her role as Chairperson of the WCET Education
Committee has also been busy working with ET students and
nurses in some countries assisting them to conduct courses as
well as improving their skills and knowledge. I know she is
always on the lookout for people to go with her to some of the
Third-World countries, so please contact her if you can.
Our membership numbers grew significantly at the Perth
conference but some people have not paid this year’s subscription
yet. If you haven’t paid or would like to join as a new member,
log onto WCETN.org and fill in your details. It is a good time to
join or renew now as our exchange rate with the English pound
is very favourable. Also you receive a greater discount to the
Phoenix conference than the cost of the WCET membership, so
you are really saving money!
Pleases continue to contact me if you have any concerns about
WCET and come fly the flag with me and other Aussies at the
close of the conference in Phoenix when we will be doing a small
presentation to promote the 2012 conference.
State reports
Australian Capital Territory
Northern Territory
Greetings all. It has been a busy start to 2010 in the world of
stomal therapy for us, both in the acute and community settings,
with record numbers of new ostomates in the first three months
of the year. Hopefully we get to catch our breath before the cold
sets in.
The Northern Territory has been busy of late with loads of
changes at the wound and stomal therapy front. We would like
to welcome a new stomal therapist to the role at Royal Darwin
Hospital (RDH), Donna Fisher, who previously worked at Alice
Springs. Donna is now working part-time at RDH and brings
our numbers to four stomal therapists employed in the NT. I
will be taking a step back from stomal therapy as Donna takes
charge of the stoma management in RDH, whilst I take on a
more extensive wound care focus as I expand the role of wound
management nurse practitioner at RDH.
The ACT Stoma Association held a social gathering last month
and over 90 ostomates and some company representatives
attended. It was, by all reports, a fantastic afternoon and Judith
Barker, nurse practitioner, was an informative guest speaker at
the event.
Kellie Burke
Gail McBean and Chris Clarke continue to work in their
respective roles in the Darwin community setting as stomal
therapists and continence and wound advisors. It looks like 2010
will be an exciting year and more changes are afoot.
New South Wales
Looking forward to seeing you all in Phoenix at the WCET/
WOCN conference
Regards,
The NSW Branch continues to meet second monthly, with an
education session at all meetings. All branch meetings are held
by teleconference throughout the state and all members are
welcome to participate. This is working very well, with many
more members in remote areas of NSW being able to participate
in these meetings.
That’s all from the NT for now.
Two guest speakers attended our April meeting. Mr Michael
Peebles AM, the new general manager of ONL (Ostomy NSW
Ltd) spoke about his new role, the members, volunteers,
supplies and changing services within the ONL. We welcome
Michael to his new position and his plan for a better service
for our ostomates. Janet Forsyth, a private STN, spoke about
patients problems following discharge from hospital. Both
speakers were extremely interesting.
Queensland
Carol Stott has been invited to be an educator at the 5th
ETNEP (Enterostomal Therapy Nurses Education Programme)
in Indonesia, in the first two weeks of May. Carol has done this
before and found it an extremely rewarding experience. We are
all waiting for an interesting and enlightening presentation from
Carol when she returns.
Congratulations Helma Riddell STN, Wagga Wagga, who has
been elected as the Vice-president on the National Committee.
The branch wishes her well in her new position.
Our next guest speaker at the June meeting will be Eleanor
Galt, clinical psychologist, previously from Concord Hospital.
Eleanor will talk on psychological issues and the ostomate. The
meeting dates for 2010 are 1 June, 3 August, 3 October and 3
December. For teleconferencing please call me.
If you are an AASTN member and do not get our branch
minutes please contact me on 9515 8990.
Cheers,
Jenni Byrnes
Due to inclement weather, our state AGM was postponed and
held on our professional education day on 12 March 2010. The
following officers were elected:
President:
Vice-president: Secretary: Treasurer: State Rep: BOSVS: Education:
National Editor:
Jan Fields
Colleen Pope
Petra Prokop (re-elected)
Maxine Wench (re-elected)
Helleen Purdy (re-elected)
Shirley Jones
Ros Probert (re-elected)
Pat Sinasac (re-elected)
Theresa Winston
Theresa Winston and Emma Vernon are being mentored this year
to take over positions in 2011. Elaine Lambie was presented with
a special gift for her role as president over the last eight years.
We thank her for all her hard work, support and dedication to
this role. Also, a big thanks to Sarah Axman-Friend for all her
hard work as national treasurer.
We had 52 STNs from Queensland and Northern NSW attend
our professional education day, as part of the national AGM,
at the Princess Alexandra Hospital. Excellent case studies,
evaluating a stoma tool and experiences as a nurse practitioner
were presented, which provided the opportunity to share
experiences, network and mentor the novice STNs and students.
We plan to have further professional education days.
Cheers,
Jenny Rex
Claire O’Donoghue decided to retire in early 2010. Claire has
worked as an STN for Bluecare in the Beenleigh region. We
33
craft’ was nurtured and encouraged to spend time in the department
and do their ST training. Val was an active member in the AASTN
at both state and national level from the mid-1980s – she held
positions of president; secretary; state rep and national conference
planning committee member and was a regular at the monthly
meetings at the Mater Hospital. She was held in high esteem by
her state and national colleagues. This carried on to the ostomy
associations and ostomy company reps.
thank her for her service and commitment to stomal therapy
nursing and to the AASTN Queensland branch over the past 22
years. We wish her all the best in her retirement.
Sadly, Val Wright passed away on Tuesday 23 March 2010. Val
was an extremely dedicated STN and had worked at the Royal
Brisbane and Women’s Hospital for over 35 years. Val has
mentored many STNs through their course and will be sadly
missed by many colleagues.
I have included a beautiful eulogy presented by her close friend
Shirley Jones, who worked with her for many years:
I first met Val in 1994 when she was charge nurse of ward 7FE at
RBWH, a position she held for many years. I was being introduced
by STN Cathy Fritz and remember being greeted warmly and drawn
in to a welcoming hug that seemed to envelop me completely! And
so began the many of such instances as our paths at the RBWH
eventually merged in the nursing speciality department of stomal
therapy.
Cathy Fritz gave Val the nickname Aunty Val, shortened to AV
– though only she would directly address her using this ‘term of
endearment’! Val loved her work – her absolute focus was for her
patients and their wellbeing, ensuring they were afforded the best
possible healthcare. She advocated, usually quite vocally, for as long
as it took to have the best possible outcome for her patients – she
expected nothing less from her fellow health team colleagues. Clinical
practice was her passion – anything non-clinical was undertaken
somewhat reluctantly.
Everyone at RBWH knew Val – wherever we went she was greeted
by someone. I suppose that’s to be expected, working there for 35+
years. She was larger than life; an ‘institution’; a little scary!! Val
held strong opinions and stood firmly by what she believed in. She
was fiercely independent. She did not like to be made a fuss of. She
was a very private person.
Val took great pride in teaching nurses about stomal therapy and
wound management. The sessions we ran were very interactive,
included humour and involved the odd digression to get important
messages across. Anyone who showed an interest in learning ‘the
34
I worked with Val for many years. She called me Shirley Bean,
sometimes shortened to Bean – not sure why. I sometimes introduced
her to patients as ‘Geri’, short for ‘my geriatric colleague’ (a term of
endearment!!) She was tall, I was short: rather like the ‘odd couple’.
We developed a working relationship that complemented each other’s
strengths and weaknesses. It wasn’t always smooth sailing – we
operated very differently – but, at the end of the day, providing
excellent patient care was the focus we both shared – we just used our
own unique path to achieve the best outcome. She used her teaching
skills to get the best from her patients, whether it be with humour
and wit or firm encouragement (‘get on with it’). She spent many an
hour sitting on the bed comforting patients or loved ones who were
despairing.
Some of the things that come to mind when I think of Val: Her silver
blond hair drawn up into a French roll; her ‘matronly presence; her
stoicism; her loyalty and generosity; her greeting ‘hello honey how
are ya’; referring to husband Paul as ‘my husband’; the red Dansac
peg on her name badge; her love for her dogs – Sooks (her diabetic
pooch who was blind and on twice-daily insulin), her beloved Bole;
reading a library book at her desk during breaks; dancing lady
orchids; delicious curries, desserts and cakes; lemon ginger tea;
wicked laugh, sense of humour and quick wit; lavender; going to the
ballet with Margaret Cameron; pashmina wrap; sayings ‘Val Wright
ST‘; ‘division of labour’; Hi honey, how are ya; her pride in her
friends and their kids; the stomal therapy department office: paper
piles; clutter; the map of Queensland on the window.
Val was a very private person, which is why so many were shocked
to hear of her death. This was her wish. She experienced so many
heart breaks, so many challenges in the last 12 months of her life,
culminating in her own ill health. She fought a courageous fight.
It was a privilege to be part of the group of friends, family and
colleagues providing support and assistance during these past
months. Rest in peace Val, up there with Marg, ‘sorting Heaven out’.
Your STN colleague and friend Shirley J
Thank you to all the states that sent us their condolences.
Cheers from Queensland,
Helleen Purdy
South Australia
South Australian stomal therapy nurses have had a mixed start
to the year. For those involved in planning for the 2012 WCET
Congress meeting, the pace has been fairly constant, with emails
flying back and forward, while those of us less involved are
taking life at a more leisurely pace.
The year started with a meeting at Wendy Humphries’ with a
day of archival sorting of AASTN material, accompanied by a
BBQ lunch to make the chore more enjoyable. Paper shredders
were mandatory accompaniments as was a salad. After three
hours, all the documentation had been reviewed, although there
were a few papers still to be sorted at the end of the day.
The second meeting for the year was held at the Alzheimer’s
Association on 24 February and no guest speaker had been
arranged, since discussions were to be held about funding
members going to Phoenix for the upcoming WCET meeting
and to organise the year ahead. Ongoing discussions about
what the meeting format will be this year continue, but monthly
meetings for those involved in WCET planning are to take place
to ensure smooth organisation for the event.
The AASTN AGM was held on 12 March in the Royal Adelaide
Hospital, but the numbers were few. This was probably due to
the activity in the city associated with the Clipsal 500 car race
and the Womadelaide music festival, which were going on at the
same time, making parking in the city a nightmare.
A more recent stomal therapy meeting was held on 31 March
and, again, the main topic of the meeting was how to format
the year to ensure that those involved in planning the WCET
congress meeting were able to make the most of their time after
the main body of the SA branch meetings.
Perth hosted the Australian Wound Management conference this
year with a fair number of our members travelling west for the
event. The programme looked informative and exciting and I
am sure that all those lucky enough to have attended will have
enjoyed the event.
The year is shaping up to be dominated by the planning and
preparation for the WCET 2012 meeting, but I hope that I am
able to report on some other news from South Australian stomal
therapy nurses.
Lynda Staruchowicz
Tasmania
Hi everyone,
Our entire team has been very busy and working extremely
hard; keep up the great work girls.
We are very excited to report a new position and new team
member to our state and team. The Mersey hospital in Latrobe
has created a new part-time position incorporating, like the
Burnie position, both stomal therapy and breast cancer support.
This is absolutely fabulous for the community of Devonport and
its surrounding areas to have a stomal therapy nurse much more
accessible. So, without further ado, we are thrilled to introduce
the successful applicant – Andrea Hicks. Congratulations
Andrea!!
Andrea successfully completed her Graduate Certificate in
Stomal Therapy through NSW College of Nursing in 2001, after
which she covered leave at the LGH for extended periods, not
only in stomal therapy but also in the worlds of wound and
continence care. Andrea’s most recent position has been in the
much valued project of ‘Hospital in the home’. I personally
very much look forward to working and sharing the NorthWest region’s growing client base with her. Also, as a close and
committed state group we’d all like to say, “Welcome aboard
Andrea”.
In other news, we once again congratulate Vanessa Rhodes from
the Royal Hobart (RHH) for accepting the significant role as
National Treasurer. All the best with that Vanessa.
Sonia, also from the RHH, recently attended a Victorian
conference at the Peter MacCallum cancer centre entitled,
Colorectal Cancer: A Multidisciplinary Approach. Sonia reports that
this was very dynamic and interesting. It’s great to see that the
multidisciplinary approach is now recognised and supported as
valuable. When each speciality contributes their own expertise
with knowledge, commitment and passion, I believe there can
be huge patient benefits and hopefully improved outcomes by
such a process.
We have had a lovely summer here in Tassie but as I close I must
say that the temperature is certainly dropping. So I’ll wish you
all well and warmth as we in the cooler states will seek out our
winter woollies.
Kindest regards,
Tracey Beattie
Victoria
Following our AGM, which was held at the end of our country
study day, at Geelong Hospital, on 12 March 2010, the Victorian
branch committee members are as follows:
President
Stefan Demur
Vice-president
Helen Nodrum
Secretary
Cheryl Prendergast
Treasurer
Lynne Bryant
State Rep
Patricia McKenzie
Committee
Lisa Wilson
Sue Vaughan
Marg Lucas
Country Rep
Lynne Nicholson
Victorian branch members who hold national executive positions:
Margaret Fraser, Secretary
Genevieve Cahir, National Committee
Diana Hayes, SPAP liaison, Government scheme
Carolyn Atkin, VIC Representative on the committee for WCET
2012.
Wendy Sansom and Jenny Davenport, National Education
Representatives
Wendy Sansom/Stefan Demur, NNO representatives for
Victorian meeting.
35
Stefan Demur has taken over the President’s roll, allowing
Helen Nodrum time to concentrate on her commitments, on the
organising committee of the AASTN Tripartite Conference, in
Cairns, 3–7 July 2011. We welcome Stefan to the President’s role.
The planning of this event is well under way and is progressing
smoothly. The theme of the Conference is: Leaders in Practice –
Captured in Paradise. Please see the article from the committee in
this journal for further details.
Australian Association of Stomal Therapy Nurses Inc.
Education and Professional Development Subcommittee
Position Statement
Scope of nursing practice for stomal therapy nurses
It is recognised that stomal therapy nurses practise
in a variety of settings and must operate in accordance
with their scope of practice as determined by their
relevant state registering body.
A study day was held, prior to the AASTN Annual General
Meeting, at the Geelong Hospital. It was well-attended, providing
an interesting and varied approach to the management of highoutput ileostomies. This session was organised and presented
by Lynne Bryant and Stefan Demur, stomal therapy clinical
nurse consultants, at Geelong Hospital. They should both be
congratulated on their endeavour.
Stoma Appliance Scheme:
updated schedules
A timetable of meetings and educational events is available
on the AASTN website. This will be updated regularly by
yours truly, so please we ask all members to check the website
regularly so as not to miss out on coming events. Future meeting
dates organised so far for this year are
Available from the Department of Health website
www.health.gov.au/stoma
If the page does not show immediately, use the
www.health.gov.au search system and you will find it by
typing in stoma appliance scheme
11 May – Monash Medical Centre, Clayton campus.
Commencing at 6pm, with guest speaker from Monash talking
on Cultural Issues within our Multicultural Society.
All other meetings for this year will incorporate a guest speaker
and will be all held at Nurses Memorial Centre, 431 St. Kilda
Road, (cnr Slater St.) commencing at 6.30pm on the following
dates: 13 July, 14 September and 9 November.
The Mayfield Stomal Therapy Certificate course will run this
year. The commencement date was delayed from February until
May for late applicants to have the opportunity of starting.
Diana Hayes and Rebecca Foot-Connolly have attended an
advanced clinical skills one day seminar on ERAS. We are
looking forward to their report at future meetings.
Maria Stirling at William Angliss has moved over from stomal
therapy into the role of Lymphodema CNC.
The Victorian branch was very saddened to hear of the passing
of Val Wright, an esteemed colleague and very good friend to
many of us here in Victoria. We extend our condolences to Val’s
family and particularly all in the Queensland branch. Val will be
sorely missed by many.
electronic submission
of manuscripts to the journal
The Journal of Stomal Therapy Australia now requires all
submissions to be made online
Steps to submission and publication
• Go to the publisher‘s website: www.cambridgemedia.com.au
• Click on Manuscript System.
• Login.
• Create an account if first time using the system. This will be
retained for future enquiries and submissions.
• Enter your personal details: all fields must be completed.
• Confirm your details.
Submitting an article
• Step 1 – Type the title, type of paper and abstract. Select
publication – JSTA.
• Step 2 – Confirm author. Add co-author details (all fields) if
applicable.
We look forward to a successful and productive year.
• Step 3 – Upload files. Only Word documents are accepted.
Please ensure your document contains the required information
and is formatted according to the author guidelines.
Patricia McKenzie
• Step 4 – Add any comments for the editor.
• Step 5 – Review your information then click submit.
Once submitted, the manuscript is reviewed by the editor and, if
acceptable, sent for peer review.
Peer review
Peer reviewers will be asked to review the manuscripts through the
electronic process.
36
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The Journal of Stomal Therapy Australia

Transcription

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