As I read the research report from Leslie Riggle Miller "Ostomy Care During Hospital Stay for Ostomy Surgery and the United Ostomy Associations of America Patient Bill of Rights: A Cross-sectional Study," I was reminded of the importance of patient support groups and the need for health care providers to partner with professional organizations and support groups related to our specialty. As ostomy nurse specialists we partner with our patients and their families to provide support through their health care journey, including living with a disease such an inflammatory bowel disease and/or cancer, learning to live with an ostomy (finding the best pouching system, teaching skills to manage the stoma, and preparing for and knowing how to manage complications), and supporting psychosocial/psychological adjustment (who to I tell, do I tell, and concealment, return-to-life activities). We must be sure that we are working with all team members involved in our patient's care. Miller's study reminds us that the United Ostomy Associations of America (UOAA), is an essential part of this team.

The Wound, Ostomy, and Continence Nurses (WOCN) Society partnered with the American Society of Colorectal Surgeons (ASCRS) and the American Urological Association to develop ostomy guidelines as well as position papers. The WOCN Clinical Guidelines: Management of the Adult Patient with a Fecal or Urinary Ostomy1 provides a blueprint for ostomy patient care focused on the health care provider as are the ASCRS Ostomy Guidelines.2 These position papers provide guidance on stoma site marking for the clinician.3,4 The Ostomy and Continent Diversion Patient Bill of Rights (developed by the UOAA)5 defines specific interventions that the patient undergoing ostomy surgery or living with a stoma should receive. This document (which the ostomy community may not be familiar with) supports the care of the person with an ostomy, and we should incorporate the Guidelines (WOCN and ASCRS) the stoma site marking position papers as well as the Patient Bill of Rights (UOAA) in the care of a person with a stoma. Collaboration between all parties is necessary to deliver high-level ostomy care.

I found Miller's report that only 42% of people who have undergone stoma surgery reported hands-on instruction on pouch management, that only 35% received hands-on ostomy instruction and reading material, and that 40% had no supervised pouch change before discharge deeply concerning. The study did not ask if the person with an ostomy had access to an ostomy nurse specialist. The findings may reflect that there was an access issue to working with a certified ostomy care nurse: All patients undergoing ostomy surgery should have access to a certified ostomy care nurse.1,2,3 These findings remind us that even though we may believe we have taught patients the necessary skills, many either have not received the necessary education or were unable to retain the information. I assert that we need to examine who is delivering the care, how certified ostomy care nurses can support other caregivers, how we engage surgical staff and our patients, and most importantly how we can help ostomy patients access care of a certified ostomy care nurse. The surgical staff must be familiar with the goals of care before surgery (a stoma with protrusion in a good location if at all possible). Similarly, nursing staff must understand what patients should accomplish before discharge (demonstration on emptying/changing the pouch, information on troubleshooting, and resources) and communicate readiness for discharge with the surgical team in order to prevent early discharges with potential readmission.

Similarly, patients need to understand the goals of care before undergoing surgery, and resources to address stoma issues such as adaptation, pouching options, and related fears or misconceptions. Patients also need to understand what skills they need to acquire before hospital discharge. These skills are outlined in both the guidelines (ASCRS and WOCN) and the Patient Bill of Rights (UOAA). I suggest all ostomy nurse specialists familiarize themselves with the Ostomy Guidelines (both WOCN and ASCRS) as well with the UOAA Patient Bill of Rights, in order to develop a comprehensive plan of care for our patients.

Multidisciplinary collaboration must be our goal using the tools such as the WOCN and ASCRS Ostomy Guidelines and the UOAA Patient Bill of Rights to help us better meet the needs of our ostomy patient population.

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