Title : Improving the dietary guidance in patients with a newly-formed ileostomy in a district general hospital in the UK
Abstract:
Background: Ileostomy formation is a common operation in the UK amongst certain patient groups including inflammatory bowel disease, colon cancers and other colorectal diseases. In certain UK centres, there is no written dietary guidance given to patients discharged with a newly-formed ileostomy, with patients often reporting uncertainty about adequate nutritional intake and recognising stoma complications. I describe a Quality improvement project (QIP), used to create a standardised written reference on dietary guidance for patients with a newly-formed ileostomy on discharge.
Methods: An initial qualitative questionnaire was carried out on 40 patients with a newly-formed ileostomy to establish baseline patient knowledge on dietary requirements and stoma complications. These findings suggested a lack of education and recognition of complications amongst this cohort. Collaboration with dieticians and stoma nurses led to the formation of a dietary reference sheet for this cohort of patients. A further post-change qualitative questionnaire was carried to assess the effect of the changes implemented.
Results: Baseline research suggested a lack of knowledge in ileostomy care, dietary and nutritional requirements and variation in clinician guidance within the same centre. After implementation of a dietary reference sheet in this cohort, a post-change qualitative questionnaire was carried out. In this cohort of patients, our findings demonstrated a 60% increase in confidence in recognising suitable food choices, an 80% increase in confidence in recognising suitable beverage choices, and a 60% increase in knowledge surrounding common stoma complications post-operatively. In this cohort, 34 out of 40 patients supported written guidance on dietary and nutritional requirements.
Conclusions: In patients with a newly formed ileostomy secondary to colorectal disease, standardisation of written dietary guidance created by local clinicians in collaboration with dieticians and stoma nurses demonstrated a significant improvement in patient confidence regarding meal choice, navigating common post-operative complications and overall contributed to patient safety. This QIP was beneficial in reducing variability in clinician advice, reducing patient knowledge gaps, empowering patients on the self management of stoma care and recognising complications.
There is evidence to suggest a knowledge gap on dietary and nutrition related subjects amongst allied health professionals, clinicians, and within the medical school curriculum. Through the creation of a dietary reference sheet, this reinforced education and guidance amongst resident doctor’s and reduced their knowledge gaps, and allowed for consistent advice to patients. Therefore, this QIP helped further clinician education, and fostered multidisciplinary team involvement in improving patient care.
Overall, the created dietary reference leaflet was integrated into the standard discharge pathway for all patients with a new stoma. There is a plan to re-assess knowledge at future intervals to see if there evidence of sustained knowledge, and if any further changes can be implemented to improve patient knowledge, safety and outcomes.
