S5E1 Coloplast Intro - Welcome to Stoma and Continence Conversations from Coloplast Professional. I'm Hannah, Ostomy Care Associate Education Manager at Coloplast. Working in specialist care, I know that stoma, bowel and bladder issues impact the lives of those you care for. This podcast is here to support your educational needs and help you in supporting your patients. You'll hear from fellow healthcare professionals and experts by experience, discuss the latest hot topics in the world of stoma, continence care and specialist practice. Hannah: Hello and welcome to this podcast, or should I say welcome back to our first of the new season! We are on season five now of our Coloplast Professional podcasts, so welcome back! So today we will be discussing how we can bring audits to life. Back in 2019, over 2000 stoma care nurses across 27 countries came to consensus leading to changes in the care regime for thousands of stoma patients around the world. The guidelines have been published three times now, including the British Journal of Nursing and the research generated practice guidelines are designed to lead to better outcomes, and higher quality of life for stoma patients. At this point, I'm going to bring in my colleague, ostomy care education manager Paul Russell Roberts, to discuss a little bit further. Hi Paul. Paul: How you doing Hannah? It's strange, me being the one on this side of the mic going be being interviewed, it's normally me that side with you! Hannah: The interviewer is now the interviewee! Paul: I know, don't things change, don't things change!? And thank you so much for that introduction. And I was lucky enough to actually be one of those 2000 nurses when the original consensus was undertaken and it was finalised in Copenhagen, and it was a fantastic day, as I said, having thousands of stoma nurses together. It was an amazing once-in-a-lifetime experience. Following that experience when I actually saw the final article come out with these guidelines, etc… As you know, I am a little bit of a, I like digging and I don't always believe numbers! And I know for a lot of people when they read an article, it kind of goes, ‘oh, that's a really interesting conclusion, that's a really interesting result.’ But how many of us can actually say that hand on heart, it changes practice that we do? Unless it really, really does grab us and intrigue us with the conclusion. So what I thought with this is what does the next stage of this look like? What can we do to prove that final statement? Because that final statement's actually quite a broad and quite a powerful thing of, you know, ‘it will lead to better outcomes and a higher quality of life.’ So as a stoma nurse, that's what we want. We want better outcomes. We want to get it right first time. We want a higher quality of life for the patients that we care for. So I had this idea of creating the consensus audit. So what did this audit actually look like? It was a multi-centered approach, so we actually covered 33 unique hospitals and in those 33 hospitals, 33 sites, we audited 147 patients. 111 of them were new and 29 were established. And for those of you that are very quick at maths, yes, 111 plus 29, doesn't equate to 147! But for those of you that have ever done any research, you always get a little gap, and there were seven patients unfortunately we didn't know whether they were new or established. So unfortunately those results we had to take out. The order included a first clinic review, or a review immediately prior to discharge. And what did we do on those reviews? It was a DET score, an OLI score, so an Ostomy Leakage Impact score, and a body profile score. Now, it's important to say that this wasn't a piece of research, it was auditing. So all we did, it didn't say, we didn't ask for it to be, you know, care to be changed, anything like that at all. It was just assessing our care and our practice. Once we got those results, the initial preliminary results were really quite interesting. There were some things where it gave really a lot of discussion when we were actually looking at the initial results. Not random, but we got some really interesting results that we needed to look into a little bit more. So what we actually did is we undertook a focus group, and this focus group consisted of 16 clinicians who took part in the original audit so one of the 33 sites. This was completely independent. It was run by the Bain Group, and the purpose of this was just to discuss some of those findings that we actually had. Hannah: So you're saying there was some unexpected results in there? Paul: Yeah, because obviously, you know, we've got the research from the Ostomy Life Study, and I'm going to put a plug in here... The Ostomy Life Study, is available on the Coloplast Professional website. So if you haven't been on it, please go onto the Coloplast Professional website coloplastprofessional.co.uk , where you can see a breakdown of the percentage of ostomates who have a regular body profile, an inward body profile, an outward body profile. But those numbers, didn't correlate with the patients that we were seeing from the audit. But also, if you kind of go with the body profile, the body profile numbers weren't matching the base plate selection upon discharge. So we needed to dig down just a little bit more to try and get that key understanding. Hannah: So when you're saying body profiling, base plate selection was different… I presume we are meaning that, so with an outward body profile, we'd expect more use of concave. Inward, we'd expect more use of convexity. Regular, flat. So there wasn't marrying up of those information and details then? Paul: Yeah, it was really interesting. So, for instance, if we look at the spread of body profile, this is at the initial review. We had 54.4 percentage were regular, 23.8. were inward. and 21.8 were outward. But when you look at the spread by base plate type 50.3 were discharged on a flat, so you've got almost a 4% difference there. 37.4 were discharged on a convex with only 23.8 on an inward and 12.2 on a concave with 21.8 on an outward. Now for anybody listening to that, and I know when I looked at it, I kind of went, well, that kind of makes sense because it's not always, there's so many other factors, especially when you're doing the body profile assessment that we need to take into consideration when we're making that base plate selection. So having that kind of variance, it went against the grain… but when you dig down that little bit more, you kind of think to yourself, well, actually it does make sense. So again, it was a really, really interesting part of that audit when we got those results back. The other thing that we were talking about, we looked at with the audit was DET score. So it wasn't just about body profile and base plate selection, it was also about DET score and how an individuals peristomal skin and the condition of a patients peristomal skin had an impact on their quality of life using the OLI score and the results from this really did support the prevention over cure messaging and mindset that we're trying to think about now. Because there was this really, really strong correlation between the higher someone's DET score, so the worse their skin was, and the lower their quality of life. So again, it's something that we all know is it's the worse someone's skin is, the worse their quality of life is going to be. Hannah: So were you able to see if there was any pattern on the body profile to do with the quality of life or even the DET score? Was there any patterns showing in that when it came to the audit? Paul: Well, again, it's really, really interesting because we know the importance of achieving that seal and making sure we don't get into that horrible leakage cycle of leakage occurs, which, and we all know that leakage leads to peristomal skin complications. The more peristomal skin complications you have, the higher the likelihood of leakages. The more leaks you have, the more risk of peristomal skin damage. So you get into this vicious cycle, and we all know the importance of not getting into that cycle. So we know that the higher the DET score, the lower the quality of life. But one of the other things we actually looked at was, we were able to break this down and actually have a little look at the DET score and the OLI score for each body profile and each section of the body profile assessment. So for instance, the individuals with a regular area around their stoma had a much lower DET and actually had the highest quality of life. Those individuals with an inward area had the highest DET score and a median OLI score, which is a really, really interesting result, which I'm going to come back to in a second. And then an outward body profile had the median DET score, so it was right in the middle, but it actually had the lowest quality of life score. So again, when I think about that, and when we talk about that, and we discuss that… So the inward body profile have the higher DET score. So we know that individuals with an inward profile are at a higher risk of developing parastomal skin conditions, but those individuals with an outward profile actually have a lower quality of life. So are there other factors, be it intrinsic or extrinsic factors that are reducing the quality of life for those individuals with an outward body profile? So when we are communicating with these individuals, does our questioning have to be slightly different? Do we have to look at things in a slightly different way and potentially look at more things like body image and, you know, and all those other things that we don't, you know, again, we try our hardest to make sure we cover, but potentially with people with an outward body profile, do we really, really need to focus in on those other factors as well as achieving a seal and that leak-proof seal for around the stoma? The other things that we kind of looked at in this, which were really, really interesting was soft abdomens and firm abdomens. So when you look at soft and firm, somebody with a really soft, lax abdomen again had a higher DET score and the lowest quality of life. And that firm abdomen had the lowest DET score and a better quality of life. So again, thinking about that soft abdomen, are we thinking about that in respect of base plate selection? Are we thinking about supporting products? Are we thinking about utilisation of some convexity to support that soft, lax, parastomal skin? So again, it's something that we need to actually dig down in and have a little bit more of a closer look at potentially in the future as well. So again, what I would say to people is go onto the Coloplast Professional website, have a look at this article, or if you've got an Athens password there, you can have a look at the article on there and have a little look at that table and you can see that breakdown of the, you know, the section of the body profile, the DET score, and the OLI score and it is really, really, really interesting results. Hannah: So, now I know we also said at the start of the podcast that this research was aimed to lead to better outcomes and higher quality of life for the patients. So we've got the research there, which shows the correlations of DET scores, quality of life, body profile... So how are we to now use this to help create those better outcomes? Paul: Brilliant. Because I think that that kind of does lead us on to the focus group because that was one of the questions that we actually asked within the focus group. So part of the discussion was about, leading to, you know, how we can make sure we lead this to better outcomes. And what the focus group actually told us was, you know, that these tools are easy to use, you know, and it did help them in ensuring that they did use the right stoma appliance for each individual. So, as you say, we didn't, you know, this whole audit, we weren't asking them to change their practice. It was more think about their practice. So they didn't have to go on any specific company product or anything like that, there was no change at all. But what it did help is, it helped ensure the right product was chosen for the right individual. And there was one little bit here that when I was actually reading through the initial transcripts from the focus group and when we got the original numbers, 46.6% of participants indicated that the tool saves time. And I kind of looked at that and I went, oh, you know, I kind of initially saw that as a negative because that would mean that over 53%, just over 53% indicated that the tool actually adds time to their assessment. But, there is a but in that sentence! So 53.3% indicated the tool adds time to the assessment, but… it reduces the patient return visits! Hannah: So ultimately reducing overall time! Paul: Exactly! So it's that thing of a stitch in time, saves nine. So you know by improving patient outcomes at the initiation stage and having this assistance by validated tools, then you can do the appropriate pouch changes, and then it stops individuals going into this horrendous leakage cycle that we see all of the time. So a really, really powerful bit of information taken directly from the focus group, which we wouldn't have got if we'd have only just done the paper exercise of the original audit. So a really, really interesting and I think vital piece of information. Hannah: As we know, one thing nurses are very short on now is time, so anything that can save any time, be it at the point of that initial contact as was it 47% you said found it saved time at initial? Paul: Yeah, just under 47% said that it saves time. And I said over 53 saying that, yeah, it adds time, but in general it reduces the amount of time. So using these validated tools supports it. And as I say, the things like the DET tool is the recognised tool, the ASCN recommend. I know we used an OLI tool, the OLI quality of life for this, but if you are interested in monitoring quality of life, then the ASCN recommends the Stoma Quality of Life. And again, that is available on the Coloplast Professional website. So the Stoma Quality of Life tool is there as well. So if you want to, if anybody's listening who is thinking, actually I want to participate in an audit, cause audits can be incredibly dry and tedious. You know, when we think of audit, I don’t know about you, Hannah, but I kind of always, you know, go back to my days where it's like hand washing audits and you know, assessment audits and you know, has the Waterlow been assessed? Has the MUST been assessed? Are you washing your hands properly? Are you doing this? So that kind of audit... Which, you know, yes, it's vitally important, but I think this audit really does bring to life the care that we provide to individuals. Hannah: Well, this audit sounds like it's going to initiate change in a positive way, not just for patients, but also for nursing as well? Paul: Yeah, exactly. You know, and it's all that thing about getting it right first time, and if we can get it right first time, it is going to lead to change. And that leads us to the focus group really did identify some really compelling reasons to support using the body profile tool, the DET tool, a quality of life monitoring tool. And you can kind of split this into three main categories that, the first one being… Confidence, and by using validated tools and specifically these validated tools, it provides a clear, critical thinking, which is really, really helpful with visual cues to support a clinician's decision making process, so it increased their clinical confidence. And they said, you know, it supported their professionalism. You know, we are using these evidence-based tools. So confidence was a really, really big trend that came through the focus group. The next one was… Communication. You know, it helped to ensure that communication and the information provided during communication was accurate. It was comprehensive, it supported the documentation leading to better inter-team communication and that continuity of care, which is so vitally important for all patients. But you know, specifically for us, for the ostomy patients that we look after, because we do take annual leave, we aren't there all the time, and sometimes people do cover your clinic or you might be off sick and having that documentation, being able to see someone's assessment is really, really, really important. And finally… And you know, again, as nurses we don't always like talking about it, but financial. You know, it helps save time and money by decreasing the amount of support in product usage. You know, it decreases change. So, you know, potentially it decreases the amount of wasted product, so if somebody's needing to frequently alter their management technique and their management structure, Then, you know, it decreases those changes. It decreases the amount of visits because people aren't getting into that leakage cycle. So generally it just improved so many different factors just by simply using three validated tools within their assessment during any patient contact. Hannah: Thanks so much for that, Paul. Really, really interesting findings there, like you say, and all those results are available on our website, aren't they? The Coloplast Professional website, all the details? Paul: They are indeed. And again, Coloplast Professional website, coloplastprofessional.co.uk . And we’ll make sure that link is in the podcast description as well. So my kind of thought for that is, you know, please, please, please have a read, have a think. Because it really is important that we bring research audit and the things that we read in journal articles to life. You know, don't just take things at face value. Question, actually question what is written in articles. So, you know, my question, my final question, kind of, which I wanted the audit to answer. So did I actually answer the question that I set out to answer? You know, does the research and that, you know, the original consensus, you know, and that research that it generated in the results that it generated and the practice guidelines lead to better outcomes and a higher quality of life for stoma patients? And I can put a big, big green, tick in that box and say, yes, you know, I've got, you know, evidence from 33 different sites from 147, 140 if you take away those 7 that were undocumented, evidence, to say… Yeah, getting it right first time reduces return visits, increases clinical confidence, reduces the financial impact to the NHS of multiple pouch alterations and management alterations. So please, please, please, as I said, question, question, question. And, you know, like reading articles. I'm, as you know, Hannah, I'm so passionate about reading articles. I love reading articles. Hannah: Oh, yes! Paul: Yes. So mainly because I like picking holes in things and I like questioning my own practice. And, you know, it's, it's quite an old adage, isn't it, the time you say you know everything or anything like that, it's the time that you retire, the time that you are bored of learning new things, it's the time to retire. So please, everybody who's listening, you know, please have a passion for learning, have a passion for reading. Because we have a passion for patient care. And the best way we can improve patient care is by constantly learning. Hannah: What a great note to finish on there, and I absolutely concur, absolutely agree. Thank you so much, Paul. And then thank you everyone for listening and we will look forward to you joining us next time. Outro - Stoma and Continence Conversations is brought to you by Coloplast Professional. To learn more, visit www.coloplastprofessional.co.uk