MDS Alert
A One-Size-Fits-All Approach to Fecal Stoma Care Can Pave the Way for Skin Breakdown
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2 tips stave off decubs and related F tags. If your nursing facility orders the same ostomy appliances for all residents, take another look. That tactic can set the resident up for a pressure ulcer, warns Mary Arnold Long, MSN, RN, CRRN, CWOCN, APRN-BC, CLNC, a clinical nurse specialist in Cincinnati, Ohio. She recalls a nursing home patient with a wound around the stoma. The patient had a parastomal hernia, she notes. And "the nursing home staff had him wearing a convex wafer that was pushing in on his skin," she says. "The wafer had actually given him a pressure ulcer." Instead: "The patient needed to be in a flat wafer, but the nursing home used one wafer for everyone," she adds. "Staff should also beware cutting the opening of the wafer too large, which can cause stool to sit on the patient's skin," cautions Long. "Once the skin gets irritated and begins to break open," the last thing you want to do is cut the opening of the wafer even bigger, as she's seen some providers do. "The wafer itself can be therapeutic to the skin." Right way: Size the opening of the wafer to be up to 1/16 to 1/8 inch larger than the stoma, Long says.
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