Discharge Planning for a Patient with a New Ostomy:

Best Practice for Clinicians BPS

Best Practice Sheet

Introduction
A comprehensive discharge plan for a patient with a new ostomy includes teaching basic skills and providing information about ostomy management, available
resources, and how to obtain supplies and reimbursement. This document provides clinicians with a quick guide to the essential elements of a discharge
plan, which may be used to facilitate patient education. Other critical pieces of the discharge planning process are assessment of need for ongoing education and
documentation of a patient’s outcomes related to self-care. Thorough documentation and communication promote continuity between care providers and care settings.

Basic Skills and Information

Empty pouch Urostomy Monitor medications
Have patient practice emptying pouch when 1/3 to 1/2 Patient should drink at least 8 to 10 glasses of
Colostomy/Ileostomy/Urostomy
full and keeping the drainage end of the pouch clean. liquid a day, unless contraindicated.
Color of stool or urine may change with medica-
Colostomy and ileostomy Recognize signs of potential complications tions and some foods.
Teach patient to open and close the clamp on the Ileostomy
Colostomy
pouch. (It may be a separate clamp or built in.) Teach patient to observe pouch contents. If pills
Constipation—Instruct patient that dietary
Urostomy modifications such as increasing fluid intake and are observed, the form of the medication may need
Teach patient how to open and close spout and fiber in the diet may reduce risk of constipation. to be changed to promote better absorption. No
connect and remove night drainage container. sustained-release or enteric-coated medications or
Ileostomy
laxatives should be used. Patient should notify all
Change pouching system Dehydration—Teach patients to recognize signs
healthcare providers of the presence of a ileostomy.
• Have patient practice preparing and applying of dehydration, which include thirst, weakness,
new pouching system. light-headedness, and concentrated urine. Manage gas and odor
• Teach patient to measure and cut skin barrier Food blockage—Teach patients to recognize signs
Colostomy and ileostomy
wafer according to stoma size. of food blockage, which include abdominal
Instruct patient to consider the use of filtered
• Inform paitent that stoma size will continue to cramping, bloating or distended abdomen, nausea
pouches, dietary modifications, and deodorants in
change for the first 6 to 8 weeks after surgery as the and vomiting, watery diarrhea or no stoma output,
the form of drops, sprays, and pills.
swelling subsides. A long-term pouching system and swelling of the stoma. Patient should call a
choice should be made after this period is over. healthcare provider when total blockage is suspected. Urostomy
Teach patient to rinse night drainage container
Urostomy
Describe diet and fluid guidelines with vinegar and water, commercial deodorizer/
Urinary tract infection—Teach patients to
Colostomy decrystalizer, or diluted bleach solution (1:10) once
recognize signs of urinary tract infection, which
No dietary changes are usually necessary, but the a week and as needed. Container should be
include chills, fever of 100.4°F or greater, bloody
patient may want to reduce gas-producing foods. changed once a month and fluid intake increased.
urine, cloudy urine (clear urine with mucous
Ileostomy shreds is normal), foul-smelling urine, back pain Teach patient to seek assistance if experiencing
Patient should increase fluid intake to a minimum of in the kidney area, and abdominal pain. the following:
8 to 10 glasses daily, unless contraindicated. Chewing • Changes in output
food well will help to avoid blockage. Patient should • Skin complications
avoid hard-to-digest foods such as nuts, popcorn, and • Stoma complications
foods with skin or seeds for 6 weeks. Eating foods
• Unresolved leaking.
such as bananas, potatoes, pasta and creamy peanut
butter may help to thicken the stool.
 Resources
Referrals Manufacturer toll-free helplines Perma-Type
• Follow-up care in community Coloplast 800/243-4234
• Home health agency 800/533-0464 www.perma-type.com
• Support group/visitor www.us.coloplast.com Torbot
ConvaTec 800/545-4254
United Ostomy Association (UOA) www.torbot.com
(800) 826-0826 800/422-8811
www.uoa.org www.convatec.com Other resources
Association benefits include: Cymed American. Cancer Society
• Contact information of local group 800/582-0707 www.cancer.org
• Ostomy Quarterly magazine subscription www.cymed-ostomy.com
Crohn’s and Colitis Foundation
• Volunteer visitation Hollister www.ccfa.org
800/323-4060
Wound, Ostomy and Continence Nurses Society Familial Adenomatous Polyposis (FAP) Support
www.hollister.com
(888) 224-WOCN Group
www.wocn.org Marlen www.fapsupportgroup.org
Society can provide location of nearest WOC(ET) 216/292-7060
www.marlenmfg.com Interstitial Cystitis Association
nurse
www.ichelp.com
Nu-Hope
800/899-5017 National Institute of Diabetes and Digestive and
www.nu-hope.com Kidney Diseases
www.niddk.nih.gov

Supplies
Provide patient with the following: Medicare Uninsured
• Supplies sufficient for a minimum of two • Patients can generally obtain equipment from any • Some manufacturers have a program for free
complete pouch changes at home. (Check with supplier. supplies; check with the company for eligibility.
your facility as the policy may vary.) • Some suppliers may accept Medicare reimbursement. • A local cancer society, United Ostomy Association,
• A starter kit or other complimentary supplies • Some suppliers will bill Medicare directly, which or supplier may have donated supplies.
available from a manufacturer. A patient/family is generally viewed as a benefit. • A patient/family member or healthcare professional
member or healthcare professional with patient’s with patient’s permission (if consistent with facility’s
permission may contact a manufacturer and have • Those patients receiving home health care may
not be able to bill Medicare for supplies until they infection control and regulatory policy) can contact
these gifts sent directly to the home. any of these sources.
are discharged from home health care.
• List of equipment needed. Some insurers will
require a prescription. Private insurance (including Medicaid or
• Size of stoma when discharged and pattern equivalent)
for an irregular-shaped stoma. Patient may need to obtain supplies from a preferred
provider; check with insurance company.

This document was developed by the Wound, Ostomy and Continence Clinical Practice Ostomy Subcommittee.
Copyright© 2004 by the Wound, Ostomy and Continence Nurses Society. This document may be reproduced noncommercially for educational purposes.
The information and recommendations in this publication are not a substitute for personal medical advice or diagnosis.

WOCN Society • 4700 W. Lake Avenue • Glenview, IL 60025-1485 • 888/224-9626 • www.wocn.org