implementing a validated peristomal skin assessment instrument into clinical practice to facilitate...

Implementing a Validated Peristomal

Skin Assessment Instrument into

Clinical Practice to Facilitate the

Provision of Optimal Ostomy Care

Mario Antonini, MS, ET

Rehabilitation Center for Ostomy and Wound Care - San Giuseppe Hospital

Empoli, Italy

SC-000238-IT

Symposium and speaker sponsored by ConvaTec

The rehabilitation of people

living with an ostomy depends

mainly on the integrity of their

peristomal skin.

Maintaining a healthy

peristomal skin is therefore,

the main objective of any

healthcare professional that

manages ostomates.

THE STOMATHERAPY IN ITALY

• N. of ostomy patients: 60.000 (Source: FAIS - Italian Ostomy Patients Association)

• New Procedures/year: 16.000 – 17.000

• N. of ET Centers: 120

• N. of ET Nurses : 300

STOMATHERAPY IN ITALY: Panoramic

44,87%

21,35%

33,78%

Ostomy patients in Italy

Nord Italia

Centro Italia

Sud Italia

THE SACS STUDY: Review of the Literature

Peer-to-Peer discussion

Review of the

Literature

Peristomal Lesions

(Dermatologist)

Need for a shared and recognized

classification

The literature often classifies peristomal skin complications by early or late presentations.

Among those, what is described as “skin irritation” has the higher incidence rate.

According to Colwell et al. the incidence rate is between 18% and 55%.


According to my esperience, approximately 1/3 of Colostomates and 2/3 of Ileo-Urostomates suffer from at least one peristomal lesion.


33% 67%

Type of Ostomy

Colostomy Ileo-Urostomy

Incidence of complications of the stoma and peristomal skin among individuals with colostomy, ileostomy, and urostomy: a systematic review. Salvadalena G. Journal Wound Ostomy Continence Nurs. 2008 Nov-Dec;35(6):596-607; quiz 608-9.

1. Number of participants in each phase of the analysis.

2. Different length of the studies.

3. No definitions of skin disorders.

4. No description of the

assessment of the skin

lesions.



RECOMMENDATION 9

Assess the stoma immediately post-operatively and the

stoma/peristomal skin condition with each appliance change

using a validated classification tool to monitor for

complications.

Level of Evidence = IV

RECOMMENDATION 10

Identify risk factors that influence stomal and peristomal

complications.

Level of Evidence = III

RECOMMENDATION 17

Assessment and follow-up by an Enterostomal Therapy Nurse

(ETN) are recommended for the client and family after ostomy

surgery to decrease psychological distress, promote optimal

quality of life and prevent complications.

Level of Evidence = IIb

RECOMMENDATION 18

Educate client and family members to recognize

complications affecting the stoma and peristomal skin.

Level of Evidence = IV

THE SACS STUDY: Objectives

OBJECTIVE N.1: Assess and

classify peristomal skin disorders.

OBJECTIVE N.2: Evaluate the

correlation between blood

chemistry and severity of

peristomal lesions.

OBJECTIVE N.3: Diagnosis and

treatment of peristomal skin

disorders.

DEFINITION OF THE

PARAMETERS FOR

THE RESEARCH:

The Study group agreed

on not taking into

consideration:

- The etiology of the

peristomal skin

disorders

- the therapeutical

treatment

FUTURE STEPS

December 2003

2004

2005

February 2006

Beginning of

the SACS

Study

OSTOMY

CENTERS

• Rome

• Catania

• Messina

• Turin

OSTOMY

CENTERS

• Bozen

• Prato

• Empoli

CLASSIFICATION

OF THE

PERISTOMAL

SKIN DISORDERS

End of

the

SACS

Study

June/July

2006

Ostomy Patient

S.A.C.S.

Study

ENROLLMENT

Group 2

> 1 year

Group 1

< 1 year

Time frames

(0, 4, 12, 24 weeks)

ASSESSMENT

• General Evaluation

• Blood Chemistry

• Pictures

REGISTRATION

Data Analysis with SPSS

software

Consensus

Conference

Classification of Peristomal Skin Disorders

2* END POINT of the

SACS Study

THE SACS STUDY: Results

656 PATIENTS ENROLLED

• 380 (group 1 < 1 yr)

• 276 (group 2 > 1 yr))

THE SACS STUDY: Results

THE SACS STUDY: Definitions

PERISTOMAL AREA:

The term “peristomal” is meant to include the whole skin around the stoma (within 7,5 cm, which is the maximum size of the skin barriers available in the market), even if it is not directly linked with the stoma.

7,5 cm 7,5 cm

THE SACS STUDY: Definitions

THE PREDOMINANT SIGN:

It was decided that the classification should always refer to the most sever lesion first. Additional lesser lesions can also be classified as an option to conform to local practice.

In general, the classification should include only one “L” and one or more “T”.

L1

HYPEREMIC LESION Peristomal redness with intact skin.

SACS CLASSIFICATION

THE SACS STUDY: Classification

LESION (L)

L2

EROSIVE LESION Open lesion NOT extending into subcutaneous tissue; partial thickness skin loss.

SACS CLASSIFICATION


LESION (L)

L3

ULCERATIVE LESION Open lesion extending into subcutaneous tissue and below; full thickness skin loss.

SACS CLASSIFICATION


LESION (L)

L4

ULCERATIVE LESION Full thickness skin loss with non-viable, dead tissue (necrotic, fibrinous).

SACS CLASSIFICATION


LESION (L)

LX

PROLIFERATIVE LESION Abnormal growths present (i.e. hyperplasia, granulomas, neoplasms)

SACS CLASSIFICATION


LESION (L)

THE SACS STUDY: Topography

TOPOGRAPHY (T)

Perspective of the HCP

- I = Upper Left Quadrant

- II = Upper Right Quadrant

-III = Lower Right Quadrant

- IV = Lower Left Quadrant

- V = All the Quadrants

Patient standing in front of the HCP

The order of the quadrants around the stoma

starts in the Upper Left corner (TI) and ends in the

Lower Left corner (TIV) clockwise.

TI TII

TIII TIV

TI

TII TIII

TIV

TV TV

THE SACS STUDY: One Instrument, two approaches

THE SACS STUDY: Example Of Classification

MOST SEVERE LESION

L3

Open lesion extending into

subcutaneous tissue

TOPOGRAPHY

TIII - IV

(Quadrants III and IV)

CLASSIFICATION

L3, TIII-IV

Requests of further info about the study

Requests of partecipation in the study

Translation in many other languages

THE SACS STUDY: In Europe

• ET Centers involved

• Hospitals in Central & Northern Italy

• ConvaBase

• Brochure & Ruler

• Nursing Management of Peristomal Lesions

• Tissue Repair and Ostomy Training Sessions

• University Training Courses

Education & Training for Nurses

Insertion in Hospital Protocols

Tools to facilitate the use of the Classification

THE SACS STUDY: In Italy

THE SACS STUDY: San Giuseppe Hospital –

Empoli (Italy)

THE SACS STUDY: Useful Tools

BROCHURE

RULER

SOFTWARE

(CONVABASE)

BADGE

"Helm, full ahead," she orders. "Let's see what's on the other

side." Like another explorer centuries before her, who stood on the

brink of an equal adventure, her eyes blur with tears even as she

laughs, the reason for either response a mystery to her, rooted deep

in that which makes her human.

For even here, even now, the adventure is still just beginning ....

JUDITH AND GARFIELD REEVES-STEVENS

“Timone avanti tutta,” ordina. “Vediamo cosa c’è dall’altra parte.”

Come un altro esploratore vissuto secoli prima della sua epoca,

all’inizio di una identica avventura, I suoi occhi si velano di lacrime

mentre ride; la ragione di entrambe quelle reazioni rimane un

mistero per lei, per quanto sia radicata in profondità in ciò che la

rende umana.

Poichè perfino qui, perfino adesso, l’avventura non è che

all’inizio…

JUDITH AND GARFIELD REEVES-STEVENS

Authors:

• Mario Antonini

• Giovanna Bosio

• Luigi Lucibello

• Francesco Pisani

• Antonino Fonti

• M. Assunta Scrocca

• Gaetano Militello

• Christa Morandell

• Laura Anselmi

• Stefano Gasperini

• Diego Mastronicola

GRAZIE per l’attenzione!

implementing a validated peristomal skin assessment instrument into clinical practice to facilitate...

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